There are many processes that are classified as a chart audit review to prevent conflicts resulting from your hospital’s billing procedure.  Retrospective audits capturing the audit data from your previously billed claims can identify unsubstantiated charges resulting in overcharges or substantiated charges that never appeared on the detailed hospital itemized bill. 

Quasi-Concurrent audits are performed within the first 30 days after the patient is discharged.  These audits can identify immediate issues that can be addressed in a timelier basis. 

Concurrent audits are conducted prior to the initial bill being issued to the payer.  As long as your facility is working with experienced medical audit consultants with strong clinical backgrounds who are familiar with your facilities’ chargemaster and charging polices, this can be the most effective method to conduct an audit.  This method of audit will address missing services in the facility’s chargemaster, charges not crossing over to the detailed itemized bill, departments tardy in entering charges in the billing system, system errors created by billing multiple identical line items for a single service provided, missed charges with appropriate documentation present including physician orders, cancelled procedures billed and areas within the hospital that would benefit from a focused audit review. 

Reports need to be in place that provide precise audit details and can be statistically trended monthly by specific department.  These reports help to identify the reasons why the over and under charges are occurring and can assist the departments in establishing a corrective action plan for resolution to prevent further errors from occurring.    

Beverly J. Bredenfoerder

Vice President Audit Operations

August 15, 2012