Why Get a Record Chart Audit?
By: Thomas Cheezum, OD, CPC, COPC

Many ODs ask how they can benefit by having a record keeping, billing and coding audit. The short answer is that it will help you improve the likelihood of passing a formal audit by a major medical insurer and possibly result in a significant income increase for your practice. Also, if you bill Medicare/Medicaid, the OIG requires that your office has a written Compliance Plan. Regular record audits are an integral part of complying with those plans.

In 2021, the AMA, in conjunction with CMS, made the most significant changes in the exam and documentation criteria for the 992xx E/M codes that have been made in the last 25 years. In addition, CMS and other major medical carriers changed the reimbursement for the E/M codes so they now, in most cases, reimburse more for both new and established patients than the 920xx codes. I have seen practices which are losing $10k -$30k per doctor per year in legitimate income due to under or incorrect coding. If you are still using the 920xx codes for most of your exams, you are leaving significant money on the table.

In light of these changes, it is more important than ever for providers to properly and thoroughly document patient visits both to show medical necessity for the visit in addition to a well thought out assessment and plan for a patient’s care.

An audit can help improve your record keeping habits to meet these new criteria and also assure that you are billing the most appropriate CPT codes for your patient visits. The PECAA Billing and Record Keeping Audit Program can help you access this valuable service at a significant discount.

Let us help you improve your documentation and billing skills and assure that you are up to date in these two critical areas.

About the author: Dr. Cheezum is a Certified Professional Coder and consulted in the development of the Certified Ophthalmology Professional Coder credential offered by the American Academy of Professional Coders.

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