Auditing: Veterans and Recruits
Jeff A. Hedlind
As I am sure you are all aware, the Medical Coding and Auditing industry is undergoing drastic change, primarily due to changing governmental regulation and increased federal spending on enforcement efforts. New regulation is more clearly defining prohibited activities and generating new opportunities for receipt of scrutiny from governmental auditing authorities. This upswing in enforcement concerns this auditor as I have personal experience with the tenor of the federal government and its approach with respect to auditing functions. My concern is twofold: the majority of the federal government workforce is either at retirement age, or, is nearing this age at the same time that these agencies are ramping up their auditing and enforcement programs. This means that they will be experiencing an ever increasing deficit of qualified employees to fill these positions and have to lower the standards by which they recruit and train new employees. We all know that auditing is not, by the very nature of the work, a career that you can fall into and instantly be fully proficient. The process of developing an auditing mindset requires considerable exposure, education and common sense. There simply is no replacement, in this field, for the time and experience necessary to develop the skills necessary to be an equitable, proficient and unbiased auditor.
Because of the growing gap between the supply and demand for qualified auditors, the government’s problem is only beginning to develop. Sure enough, due to the two conflicting goals of the federal government, with respect to its auditing functions, it is altering its recruiting and hiring goals and methods. A quick review of the Office of Inspector General, Human Capital Management Plan, indicates that they are doing just that. The new OIG is focusing on recruiting younger, entry-level employees by recruiting recent college graduates from the top of their classes. Through campus recruiting, career intern programs and modified hiring criteria, they are achieving this goal. Unfortunately, the wealth of wisdom that exists within federal government programs exists in the minds of the seasoned, veteran employees. Despite altered training, internal promotion and employee retention practices, the governmental programs are finding themselves unable to transfer all of this knowledge to the fresh recruits. On the job training is only so effective and the new recruits need to develop their auditing skills in a hastened fashion to keep up with the pace of increasing enforcement and associated demand for production. Therefore, the newly hired recruits are churned through Auditor Career Training which involves some mix of classroom and on the job training. Keep in mind that the majority of these individuals did not complete auditing specific educational programs and have obtained little to no experience in auditing.
I have personally been through one of these Auditor Career Training programs with classroom, on the job training and additional just-in-time training. I am concerned about the impact to the medical audit industry due to the auditors that are being developed through these crash course programs. A newly trained auditor, fresh out of boot-camp, has no practical experience to fall back on when trying to determine what is realistic and equitable. As such, the auditing standard will evolve away from standard operating procedure and rely heavily on statutes. What I am saying may seem confusing at first because doesn’t our industry audit to ensure compliance with governmental regulations? Sure it does, but my worry is about the all or nothing approach which will prevail in the industry for some time following these new recruitments. I know this is going to happen because I have sailed that ship in the past; I expected perfection from my clients and accepted nothing less. However, as I developed, I began to understand that life does not happen in a vacuum and to rely more on professional experience than the black and white.
The fresh auditors will stick to their guns and will be inseparable from their manuals and protocol. Because of this, our work is going to remain under a high power microscope for an extended duration of time. Even more worrisome is the possibility that the new norm will persist and the opportunity for exhalation will not arise. Thus, we must audit and maintain records and supporting documentation that would appease the most carping governmental auditor, those who fail to understand that real life is well, messy. Two phrases that were universally thrown around in my past life were “If it isn’t documented, it wasn’t done” and “It is up to you to tell your story with your documentation, just make sure you can back up your claims.”
The net result of these changes is that your clients or employers will receive no compassion or benefit of the doubt from the newly recruited auditors. The ultimate goal has always been perfect documentation, perfect compliance and well supported medical necessity, but it doesn’t serve to ease my mind to know that the bar will be hung from the ceiling. I am thankful to be a member of the American Association of Medical Audit Specialists, an organization that provides resources and support to the medical audit industry. I want to conclude this article with the AAMAS Ethics Statement because I think in the world of increasing government scrutiny, AAMAS will serve as the guiding light to those employed in our special community. “AAMAS promotes a culture of professionalism that upholds the principles of integrity, the promotion of competency, legislative and regulatory compliance, and the personal and professional standards of conduct of the medical audit specialist.”
Jeff graduated from the University of Oregon in 2004 with a Bachelor of Science degree in Economics and Political Science. At graduation he earned a Certificate of Professional Distinction from the Political Science department and departmental honors from the Economics department for completing a project that evaluated the economic impact of community dispute resolution programs.
Jeff was employed by the Internal Revenue Service as a Tax Compliance Officer and Revenue Officer.
In January 2011 Jeff became the Senior Auditor for the Compliance Department at Agate Resources, a Medicare and Medicaid health plan.
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