News — Risk management

Daily perspective (pre-bill) audits help identify and minimizes billing errors by ensuring the accuracy of claims before they are submitted. This step alone can help compliance programs pay for themselves. Periodic retrospective audits involve the detailed review of clinical and billing records for compliance with state and federal recordkeeping and billing requirements. Some items to check include verifying the quality and quantity of radiographs, consent for treatment, proper coding, clinical notes to support each claim that was billed, and medical necessity.

My mantra is: “If It Is Not Written, It Did Not Happen!” Record audits must be documented. In the face of a fraud allegation this documentation can help your defense attorney make their case.

Michael Gerber in The ‘E’- Myth (Revisited) illustrates the importance of developing duplicate-able systems. He demonstrates that a business owner’s value is in their system. This makes sense (dollars too, BILLIONS of them!) Look at McDonald's, KFC, Wal-Mart, and EVERY other successful business in America. Every one of those businesses has systems that are duplicate-able, ensure consistency, and, as a result, are worth LOTS of money. Well, every one of those corporations, from KFC’s 11 herbs and spices and their special chicken pressure-fryer to Papa Johns’ fresher ingredients and better pizza, license (franchise) their systems. Those companies make oodles of money...