Does anyone know anything about this, like it is really that necessary ? They're asking for chart audits on 5 random members. Any info would be greatly appreciated.
Does anyone know anything about this, like it is really that necessary ? They're asking for chart audits on 5 random members. Any info would be greatly appreciated.
We seem to get audited all the time for Aetna and other MEDICAL insurances. Always random charts. Usually more than 5. Years ago I remember getting audited by VSP. It was a pain. They looked at the charts and didn't recognize symbols. For example, if you marked a zero for where medications are listed, you would assume that the pt was not taking any meds. VSP took it to mean that you did not ask the patient because you didn't write "no medications at this time." They were very picky. That was years ago... no idea if they are still like that.
It is agreed upon in your contract that you comply with audit information requests. Whether you comply or not is up to you, but what if anything Eyemed does in response is up to them. They can garnish your payments as penalties until you comply, or at most simply cancel your provider status due to contract violation. I guess they could sue for breach of contact, but I've never heard of that happening. You'll probably get many reminders to comply, with increasing earnestness, before action is taken. Unless your willing to give up taking Eyemed, just give them the charts and slog through the inevitable detailed explanations they'll need (because as mervinek said, they won't understand on their own).
There is specific medical terminology that should be used in your charts. "0" does not mean "none." There are plenty of books available to bring you up to speed.
I've had one, we had to produce not just the records but all records for all submitted materials. I think there was 10 patients in our audit, 8 of whom purchased materials. So, I had to go digging out Frame and Lens invoices. Including, if we submitted Frame and Contact lenses, we had to produce the Frame invoice, the contact lens invoice, and the lab invoice (since Eyemed rules prohibit selling frames with demo lenses in them)
ugh, thanks everyone
I have to agree with rbaker. Things are generally done a certain way in the medical and allied health fields in order to ensure the best quality outcomes for patients or clients. One may not know the exact reason something is done a certain way, but there is a method to the madness. Record standards are rarely capricious in nature. (Although, don't get my started on the EHR interoperative standards... seems like a bunch of ******* drunk monkeys with brain damage wrote those...)Originally Posted by rbaker
I wonder, does the frequency of auditing have to do with the size of a practice? Our OD lived in constant fear of them and would sometimes throw daily operations for a loop to try and CYA in the event of a pending audit (the OD was particularly edgy about the prospect of a VSP audit), but in ~4 years one never came. We were a smaller, local practice, though, so I wonder if we were just completely off of everyone's radar.
I would think that if you are processing insurance/ third party billing your practice management software would make a simple task of an audit by an insurance carrier. How do you do internal audits to gauge the efficiency of your operation?
If tying all of the loose ends of a given transaction together for internal or external review is a major effort it might just be time to reexamine your business processes. In other words, you may not have the foggiest idea what is going on in your business enterprise.
We were a smaller practice when we got audited by VSP and it was only once in many years. Also, as far as rbaker stating the medical terminology...yes that is agreed. This was many, many years ago, long before everything going electronic.
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