Benefits of Peer Review for Self-Audits of Medical Record Documentation
Kristi Hudson
Third-party payers and regulatory bodies audit chiropractors rigorously. Self-audits can help, but peer reviews double your chances of a clean report.
Self-auditing is something every practice should be doing by default. It essentially means applying the same level of diligence and vigilance to your records that should be carried out anyway as part of internal records policy.
"We have investigated ourselves and found nothing wrong." Would you have complete faith in any organization that said that? Regular self-assessment can help you catch any documentation problems before the auditors show up, but two (or more) heads are always better than one. Here's why a peer review of your findings can make all the difference.
Won't My Peers Just Do What I've Already Done?
Partly, yes, but not entirely. Peers will start by double-checking essentials such as whether:
• Treatment codes are correct
• Patient care plans with clear goals were created and progressively followed
• Procedures match diagnoses
• All documents are signed (not stamped) with full names
• All sections are legible ...
... and so on. However, ticking the expected boxes is only the beginning. One important thing peers do differently is approaching your documentation from a more removed position.
This frees them from the subjectivity and emotional stress that often comes from your direct involvement in the practice. You can never provide the objectivity or cool head of an outside review and could compromise the quality and, unintentionally, the integrity of your self-audit.
That omission or alteration you made to save a client money? It could land you in regulatory hot water down the line. That pattern of treatment and billing that appears repeatedly for multiple patients? This could be a red flag for auditors to start investigating. A peer can help you stick to regulations by questioning anything that could leave you vulnerable or that doesn't seem quite right.
Peers May Know Something You Don't
The current documentation strengths and previous weaknesses of a peer could benefit you, but you'll never know unless you make the comparison. Even experienced chiropractic peers may have had to deal with an audit in the past. This will be to your advantage because they'll be able to spot if your medical documentation is open to the same negative result. Learning from someone else's error is always less expensive.
You'll notice we said that your peers "may" know something you don't. This is because not every review will be beneficial, making it important to choose wisely. The more experience peers have in your field (and with audits in general), the more benefits their input will provide.
For example, some chiropractic peers are medical documentation specialists in which case a records review by them is most definitely in your best interests. It's through their advanced and compliant-current insight that your practice will know the benchmark that must be met.
The Potential Financial Benefits are Huge
The money invested in leveraging the expertise of a peer review can save chiropractors thousands— perhaps hundreds of thousands—of dollars should a later audit go awry. An example we spotlight on our site is of a doctor who was overpaid $1,680 by Medicare ... only to be fined $317, 034 as a result!
The administrative and financial benefits of a qualified peer review can't be overstated if you want to impress auditors and steer clear of crippling monetary outcomes.
Kristi Hudson is a certified professional compliance officer (CPCO). She serves as the Director of Business Relationships for ChiroHealthUSA where she has helped to educate DCs and CAs on establishing simple and compliant financial policies. You can contact Kristi at [email protected], 888-719-9990 or you can visit the ChiroHealthUSA website at www.chirohealthusa.com.
