Tips to Avoiding Dreaded Audits
The thought of "audits" sends chills down almost every chiropractor's spine. Most chiropractor clinics assume an "it won't happen to me attitude". Many feel their documentation is well organized and the odds of them getting selected for an audit are extremely low. "Some other chiropractor will get audited first, not me" is the belief held by many. It always seems to be the chiropractor down the street who gets audits, not your clinic. If these beliefs are held by you, I'm here to give you a wakeup call.
I want to challenge your assumptions and educate you about the increased number of chiropractic clinics who get audited. It is important to know your risk factors, the steps to reduce the probability of your clinic being selected for an audit and the options available to help you get through one if you are. The possibly of your clinic getting selected is very real. Once you have accepted this, the only thing left is embracing the clinical advancements that will protect and transform your practice into the clinic of the future.
Organized Clinics don't have Immunity
Simply having an organized clinic doesn't protect you from being selected for an audit. A large number of chiropractors who had never considered themselves an audit candidate, nevertheless found themselves being held hostage by a third-party payer reviewing their records. Most of these chiropractors felt they maintained relatively high quality documentation and care.
Oftentimes it is assumed low quality documentation and care clinics will be selected first for audits. But just because someone speeds more frequently than you do, doesn't protect you from getting a speeding ticket.
Even if you are not at fault you can still be selected for an audit. Some of the most ethical DCs - the ones with good records and great service - still end up getting audited. If there is just one small flaw in any of their documentation then refunded monies are extracted from future payments. Anyone can be a candidate for an audit. Therefore it is important for you to understand what is at risk if your clinic is selected and how to protect yourself in the first place.
Worst Case Scenario
Many chiropractors only believe that Medicare or another third-party pay program can request an audit. This is not true. In fact state licensing boards also have the right to review your records if they feel there might be an inconsistency in your documentation standards.
So what's the worst case? If you are found to have conspired to defraud a pay program or the government, the result will end in serving time in prison, loss of licensure and many other life altering events. Audits can be very serious matters. A more common practice happens with recoupment.
Recoupment and What it Means for your Practice
Recoupment occurs when the federal government or third-party pay programs determine you've failed to justify your patient care in your documentation in a process called "post-payment review." The most famous is the Medicare CERT review. This is a so-called friendly audit and no monies are requested. But most third-party pay audits are all about the money. These programs now have the prerogative to collect all payouts they've made to your practice over the past several years. Sometimes these recoupment amounts only total in the thousands of dollars, other times they total in the hundreds of thousands of dollars. What is most troubling is that the pay programs have no legal responsibility to disclose the total amount of the recoupment at once. They also don't technically have to tell you where they found the problem. Then there's extrapolation.
Extrapolation occurs when the pay program can't find every place they have paid you for unjustified care; instead they estimate that number for themselves. They will extrapolate based on your total records to increase the recoupment amount to their satisfaction. This is a nightmare for most practices selected. Practice growth is put at a standstill until recoupment is paid or some other legal arrangement is made.
Recovering After the Audit
In addition to the monetary loss, failing an audit creates a multitude of other administrative annoyances. These processes can drag out over many years, cutting into your practice's livelihood. In addition, if you fail documentation standards, they may impose additional education in documentation standards and place a sanction on your license. This stigma is permanently on your license. Every time you're credentialed with an MCO, this debilitating mark will show, which could mark you for partaking in the MCO.
Stand Up and Dust Yourself Off
In addition to the large sums of money paid out and the stress of reproving yourself, your clinic now faces having to explain your bad audit to your consumers. Patients who participate in the offended pay program must know their future care authorization may not be as forthcoming. Future provider panels you wish to participate in may be interested in previous audits resulting in negative outcomes.
Accepting the Challenge
Now after drudging through all the negatives of audits, what can chiropractors do to protect themselves and their practice? While there is not rock solid means to permanently avoiding an audit, there are ways risks can be reduced. What you can do is create an audit-ready practice, one that anticipates what records reviewers will want to see and prepares you for that event in everyday documentation practices.
Benefits of Maintaining Electronic Health Records
The first step is creating a paperless practice. Handwriting leaves room for misinterpretation and confusion. In handwriting, doctor's spelling, penmanship and fatigue all factor into the clarity of the note. If auditors can't read your writing, that may be basis enough to judge the record as being insufficient and result in failing the audit. There's a good chance and innocent mistake can set the doctor up for more scrutiny than anticipated in the event of an audit. Digital documentation provided by Future Health's Software has these unique advantages when compared to traditional note-taking processes:
- 1. The doctor is always in control of the central database of patient records. In the event of an audit, claims reviewers can obtain these documents without the clinic having to copy all the selected documents or to halt their practice until the documents are returned.
- 2. Electronic-record transfers mean that the auditing process and its resolution can dramatically reduce time commitment.
- 3. Digital note-taking has shortcuts. Daily SOAP notes now require only seconds.
- 4. Future Health's electronic health records come with an instantaneous editor that reads your SOAP notes, ensuring that what is meant matches with what your staff is coding for billings software
- 5. Digital records can mean a digital analysis of practice trends enabling the identification of moving outside of average practice parameters.
Be Proud of your Audit-Ready Practice
Disaster preparedness always seems worthless until the day comes when the necessity of that pre-preparation becomes acutely obvious. Talk to any DC who has had to struggle to survive the auditing process and you will understand the stress - emotional and financial - that it brings to the practice. I've spoken with dozens of DCs who survived, and some who did not. For these kinds of situations, many going through an audit see the necessity of updating their clinic record systems. They are now achieving a plan that's audit-ready. The world's best audit safety kit is found within the Future Health's digital clinic of the future.