When the 2000 documentation guidelines take effect, I will plug in the new requirements. A reimbursement specialist audits outpatient claims. She reviews 10 physician records every year for each of the 156 physicians at the 19 hospital-owned practices. The compliance department also reviews inpatient physician coding annually. The reviewers catalogue results into a spreadsheet for each physician and explain where he or she needs improvement.
Audits are concurrent so bills are held until the chart is reviewed and confirmed or corrected.
We complete a summary sheet for every record, then a spread sheet to catch patterns. Then we send this packet along with the records themselves to the doctors so they can review all that. This is a big deal because with anything less than 10, the physician's services can only be billed at level one - regardless of how sick patients are and how extensive an exam the physician performs on them. But she warns that Medicare auditors look for red flags like excessive use of that phrase. Doctors shouldn't rely too heavily on that.