| Learning Objective #1: audit case documentation and charges. identify common pitfalls in reimbursement for this portion of the revenue cycle. | |||
| Learning Objective #2: develop an effective action plan to maxamize appropriate rembursement. |
Method: The study was performed over a two-year period. Each case (approximately 16,000) was audited for documentation of the services provided. In addition all inventory items were audited for appropreiate documentation of usage. Par levels of all inventory items were also addressed. Lastly, all case charges were checked for accuracy and postings of those charges were verified each day.
Findings:
§ Documentation not precise nor clear
§ Charge entry challenges
§ Charge master issues (including cdm, c-code, and mapping concerns)
§ Quantity disbursement
§ Systems issues
§ Inventory management accuracy
Action plan:
§ Educate staff on proper documentation
§ Educate billing staff
§ Perform through review of the charge master
§ Increase quantity issue availabilities
§ Correct c-codes
§ Systems review
The evidenced based assessment demonstrated that for issues related to documentation alone there existed a potential loss of revenue of near $120,000 per quarter. All other identified areas totaled near $75,000 per quarter. Misrepresentation of the services provided can occur as a result of issues in any of these areas. It is essential that an internal auditing of the documentation and charges entered be performed on a daily basis and that practitioners remain current with new requirements.