Software audit tools are a good starting point when reviewing healthcare billing documents, but they are not a complete solution. Such tools have obvious limitations including an inability to definitively evaluate levels of service being reported and an inability to read and evaluate clinical documentation. Such tools can also potentially be confounded by improper coding, whether the improper coding was a result of an error, a result of ignorance of proper coding protocols and methodologies, or the result of intentional deception in an effort to garner more remuneration that would otherwise be proper.
I recently reviewed a surgeon’s bill related to a surgical arthroscopy on the knee. The surgeon had billed for the surgical arthroscopy as well as a diagnostic