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Physician, audit thyself: It's worth the expense

Your staff can do it. But spending a little money to have an outside expert check your books could reap much bigger rewards.

By Robert Kazel, amednews staff. March 21, 2005.

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Like most physicians, Mary Marshall, MD, is uneasy hearing the word "audit" in connection with her billing and coding methods. After all, whether it's a private insurer sitting down to dust off the practice's files in search of overpayments to recoup, or Medicare scanning for discrepancies that could trigger repayments and a fine, audits can make any doctor feel anxious.

But audits instigated by doctors themselves as a strategy for beefing up revenues and efficiency can be enormously helpful in an era of declining reimbursements. They can pinpoint entrenched, longstanding weaknesses. They also can help avoid hostile audits by outside payers.

Dr. Marshall, a family physician in Grand Blanc, Mich., remembers a coding and billing audit that she commissioned in late 2003 as a watershed in her career, one that taught her how to halt defeating business practices and to put in place procedures that helped her medical office thrive.

In the months before the audit, things were getting grim. Dr. Marshall, who had recently become a physician after nearly 20 years as a nurse, was grappling with an income level more meager than she could explain, poor cash flow and the realization that she had graduated medical school without learning anything about CPT and I/M codes, insurance company policies or ways to get patients to pay what they owe. A solo physician, she had 2,000 active patients and could accept no more, was working 100 hours a week, and "couldn't account for $4,000 to $5,000 a month" because of disorganized record-keeping and lax collections by her billers.