Reporting Problems Found in an Audit

Question: We have been doing self-reviews of our charts and coding procedures. We’ve found several errors, meaning wrong codes billed for both inpatient and outpatient services. We aren’t sure if rebilling with correct codes will raise red flags with our payers. However, we all believe that catching and correcting our errors prior to the payers catching them would be our best bet. Are we opening ourselves up for problems, or are we being responsible and heading off future problems?

Answer: If you discover an overpayment, you have an obligation to repay. If the overpayment looks as if it’s systemic or could have gone on for some time, get legal counsel involved. The problem will be evaluated by looking at the number of visits involved and whether there is a problem with your internal processes that you didn’t realize - for example, that your staff was changing the codes before the bill went out.

You’ll also want to have a documented plan in place for making sure it doesn’t happen again.