Sonal Patel, CPMA, CPC, CMC, ICD-10-CM, Healthcare Coder and Compliance Consultant at Nexsen Pruet, LLC, presented the webinar “Have No Fear: Auditing to Benefit Healthcare Entities, A Step Towards Proactive Compliance” recently and a recording can be viewed here. Sonal returned to answer many commonly asked questions from the webinar.
Why do you think physicians and practices are not conducting self-audits?
Great question! There’s likely a multi-faceted answer for that. But, in my opinion, I think there is not enough attention on the data. I truly believe the data speaks volumes and the data is the physician’s – they are the ones who send the claims out. Payors use that data against them when it comes to volumes of service or diagnosis errors, upcoding, overbilling etc.. I believe practices must begin taking action on their own data like I said, without fear. Do things right the first time, before claims are sent out to avoid payor scrutiny later, avoid recoupments later.
Do you think healthcare practices should have someone in charge of changes/policy updates etc.?
Another insightful question! Yes, I just gave a webinar recently where I told the audience it’s ideal to appoint a Medicare person, a commercials person – let your internal pros at that type of thing shine – let the research and policy people do what they do best and then they can disseminate to all the others.
Those are a lot of tools! Do you pay for all of those yourself? Should you expect your employer/physician to help?
Yes I do!! Over the years I have had my employers reimburse me for everything I have asked for when it comes to compliance. Open, transparent communication and strategic shopping is key. It’s imperative that compliance is robust and current!!
Sonal Patel CPMA, CPC, CMC, ICD-10-CM is a healthcare coding and compliance consultant at the law firm of Nexsen Pruett, LLC. She has over 10 years of experience in multi-specialty healthcare coding and auditing. She provides reimbursement investigations for both Parts A and B providers. Patel provides healthcare lawyers with strategies and analyses to overturn denials with private and government payors.
Be sure to view a replay of Sonal’s webinar “Have No Fear: Auditing to Benefit Healthcare Entities, A Step Towards Proactive Compliance.” You can also view her webinar, Compliant Coding & Billing For TeleHealth During COVID-19, and blog. Check out our other recent educational resources on Auditing.