Our team of professionals understand that our foremost responsibility is to serve the public’s interest through integrity, professionalism and high-performance. Quality is the cornerstone of what we do at Distinctive Strategies; it is the foundation upon which we stand and the very essence of our auditing services.
We offer our clients a broad range of high quality premium audit solutions, services, and products to help with their Vision or Medical audits. We also offer an On Site visit to review 15-20 charts. Our team will not only review your Billing & Coding processes and address any areas that your office may be able to improve on they will access other areas in your office as well.
If you are interested in more information and would like to discuss your options with one of our highly qualified team members please contact us directly for further information.
WHY DO INSURANCE COMPANIES PERFORM AUDITS, AND HOW ARE AUDITS CONDUCTED?
Audits seek to improve the quality and outcome of patient care by evaluating clinicians practices against published standards and then modifying those practices where indicated.
HOW OFTEN IS AN AUDIT PERFORMED?
It depends on the insurance company and the rules of the state where coverage is.
WHAT IS LIKELY TO TRIGGER AN AUDIT IN MY OFFICE?
Patient. An unhappy patient can submit a complaint. Perhaps she has a problem with your bill, or has trouble understanding the charges, and brings these concerns to the insurance plan.
Billing. Audits are also triggered when third-party screening systems or algorithms identify outliers in either frequency of utilization or costs of care for same diagnosis codes for a provider.
Routine. Unlike Medicare (which usually audits doctors only when a problem arises), some vision-care plans perform audits as a matter of routine. More on this later.
WHAT SHOULD I DO IF AN AUDITOR SHOWS UP AT MY OFFICE?
You should make certain your staff is aware that audits are expected. It is a process that many plans engage in, and staff should not be defensive. They should be polite and cooperative with the auditor. If you, the owner, are not in the office, someone should call you to let you know that the auditor is present, and you should meet the auditor and be available to direct the staff to produce the documents requested.
HOW CAN YOU AVOID A BIG PAYBACK?
The number one rule is that documentation really drives coding. The better documentation you have, the more options you have in coding. The worse your documentation is, the more restricted you are on what you can code. Auditors look for certain elements that make up the exam. If those elements are difficult to find or absent, the auditor can reject that patient record. Auditors evaluate patient records on something of a point system. The more detailed your patient record, the more points you get. And, the more details you have, the more defensible those records are in an audit.