That was definitely NOT money well spent. Shannon felt red-hot anger building up inside her like boiling lava in a volcano right before its eruption. She still had a hard time accepting that Blue Insurance fined her $30,000 for failing the audit and made her refund the payments she had received for all failed claims. She promised herself that she would do whatever it takes to reduce her audit risk from now on.
“Given the volume of claims, an automated monitoring system may be the only practical way to detect suspicious conduct or potential flagging for audit,” Shannon read out loud from the book Medical Billing Networks and Processes. That made perfect sense to her. She had been racking her brain for ways to implement her friend Ariana’s advice of tracking the notorious red flags for insurance companies: unsigned notes, unbilled visits, missed re-exams, and denied claims. An automated monitoring system sounded like a life saver to her.
“Does your physical therapy software help you stay compliant?” Shannon asked Ariana. Ariana was a successful PT who had been through several audits, but always seemed to emerge unscathed.
“Absolutely,” Ariana said. “There are just not enough hours in the day to help my patients and track all potential compliance issues manually.”
“But how exactly does it help you?” Shannon said. “I wonder what kind of system would be the right choice for me since I’m not exactly a tech whiz.”
“Oh, don’t worry,” Ariana responded. “Just find a system that is based on a workflow engine with multiple features. You should be able to build it around your workflow, not the other way around. It’s supposed to make your life easier, not more complicated.”
Shannon pondered that for a moment. Easier would definitely be better. But the most important part was staying compliant. “Could it also cut down my error rate?” Shannon asked.
“Yes, look for physical therapy software that has automated alerts and built-in claims scrubbing,” Ariana said. “That way you can fix any mistakes before you submit a claim to the insurance company.”
“So you are saying that the software alerts you of compliance issues and helps you manage your entire practice workflow,” Shannon said in stunned disbelief.
“It sure does,” Ariana said and smiled. “I use the software to assign tasks to my staff with tickets and complete my notes while I’m still with my patients. This makes my life so much easier and saves me so much time. My favorite thing is the Radar on the homepage, which gives me a quick overview of my practice stats so I know what is going on in all areas at all times.”
How would you advise Shannon?
Is there a way to audit-proof her practice?