Medical Practice Audit | What to Expect

As professional Medical Practice Consultants, we get quite a few inquiries about our Free Practice Audits. And not surprisingly, one of the first questions is typically:

What exactly IS a Medical Practice Audit?

After all, it’s not very often during your medical career that you’ll be involved in one. But once you have had your practice go through one, you’ll recognize the benefits right away.

By the time you finish this article you’ll recognize that you probably have good reason to inquire about an audit and will have a clear understanding about the audit process and deliverables.

Audit Logs: Stories from the Field

One Dermatology practice reached out to us because they were getting an increasingly high volume of phone calls from irate patients. They complained that THEY were getting billed for procedures that the insurance companies had already paid for.

The physicians and local staff investigated but couldn’t find where the issue originated.

We followed our typical procedure and interviewed each member of the staff – not revealing what we were specifically looking for of course. All the staff seemed competent and sincere, until we got to the person in charge of posting the payments.

That employee had become so overwhelmed with the increase in business and billing that she couldn’t keep up with posting the payments/checks that came in from the Payers. So she stashed them in a safe in the office that no one used.

This had been going on for MONTHS and represented 10s of thousands of dollars in missed revenues and patient goodwill.

Why you may need a Practice Audit

Typically, physicians or in-house practice managers reach out to Integra for a few reasons:

#1: You’re not making enough money – specifically, your practice and number of procedures and patients may have grown but it seems that your revenues aren’t keeping pace.

#2: Staffing Issues – It could be that your experience high turnover, or simply have legacy employees that you just don’t know how to deal with. Or that can be something as sinister as an active suspicion that someone is stealing from you in some way.

#3: Billing and Denials – you may be experiencing a high number of denials from reliable payers. That calls into question both the processes and people involved in getting your practice paid in a timely manner.

#4: Practice Ownership or Partnership Transitions – if you’re growing or selling your practice you’ll want to be able to clearly show that both the mechanics AND the books are flawless. Better quality numbers may mean higher payouts for you.

Audit Logs: Stories from the Field

A very busy medical practice called us about a potential issue.

They did quite a bit of cash business in cosmetics and ancillary products, and it just didn’t seem like they were depositing enough money in the bank for the inventory they were using.

Starting with staff interviews we found some very capable people on board that seemed to care about the business. No obvious leaks in their procedures were revealed either.

Finally, we asked if anyone new had started recently, and it turned out the receptionist/front desk person had been there for just a few months.

Our audit pro asked to get access to the office after working hours and searched the reception area – only to find one filing cabinet locked. Labeled “Office Supplies”. No one had a key except for the receptionist, so she was asked to open it the following morning.

She complied – reluctantly – and a manilla envelope FULL of cash was buried under reems of paper in the cabinet.  

It turns out that the staff actually didn’t do a reconciliation at the end of every day, and the receptionist knew which days it didn’t get done and helped herself to a large share of the potential deposits.

Here’s What to Expect in a Practice Audit

First of all, Integra Medical Billing and Practice Management does our Practice Audits for FREE and IN-PERSON. We’ve found no substitute for meeting you and your team in place and directly observing the people, processes and procedures in practice.

But it all starts with a phone call

Whether you call, email or fill out a contact form, we’ll schedule a call with you. Or with you and your partners and/or your in-house practice manager or office manager.

During that first 30-minute call we will do a brief needs analysis to find more about what you need. And which part or parts of your practice you want to improve or areas of concern.

You will be speaking with an very experienced professional practice consultant. No reception or pre-qualification steps here.

At then end of this call we will have a clear idea of your expectations. And if we think we can help and you agree we’ll schedule the actual audit.

First, know that we prefer that your staff gets no advanced notice.

We’ll schedule with you well in advance, but we find it easier if we make our own introductions and hit the ground running first thing the morning of Day 1.

Normally day 1 starts with observation and interview with non-medical staff. Job descriptions, what they do every day, asking them to walk us through particular tasks or processes they follow are all part of that.

Many times, these interviews lead directly to a solution to your immediate concern, and uncover additional inefficiencies, places to reduce expenses and even identify ways to reduce staff.

If no solution is found or if promising opportunities in other practice management areas present themselves during Day 1, we may extend the audit by 1 or 2 additional days.

There is never any charge or fees related to one of our free audits regardless of how long it takes us.

At the end of our on-site auditors visit there will be a brief meeting with you and whoever else you designate to review initial results and what comes next.

The final step of the Free Practice Audit is developing the Strategic Plan.

This is a written document that outlines our findings and proposes SOLUTIONs and ongoing improvements that you can make on your own, or contract with us to implement.

The Plan is comprehensive and detailed, nothing is held back. And it will include not just resolutions to the specific situation/issue you called us about initially, but also to any other areas of improvement we have identified during the process.

Audit Logs: Stories from the Field

During a practice audit that was focused in a completely different area we discovered that the office wasn’t following proper procedures onboarding and servicing new Medicare patients.

The practitioner was unaware that Medicare requires 2 things:

  • That the first visit be with a licensed physician
  • After the first visit if anyone other than a licensed physician saw the patient one would have to sign off on the notes. And that would all have to be submitted with the claim.

Another practice that missed this previously had paid HEFTY fines and lost significant revenues because of Medicare claim denials.

Payer compliance is a priority!

Next Steps

Your next step is very simple.

You can fill out the Contact Us form here. Or better yet, give us a call at (727) 233-2901 or email to schedule your initial consultation. Or we can frequently do that on your first call.

We’re anxious to help. Let’s get started!

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