Apr 15, 2025
Apr 15, 2025
Written By Elizabeth Cifers
Running a retina practice means juggling many competing tasks and feeling like you do nothing but put out fires. While compliance may not be the most exciting aspect of managing a retina practice, it’s crucial for avoiding penalties, claim denials, and potential audits. Unfortunately, many practices end up with common compliance pitfalls that can put their practice at risk.
The good news is that the right strategies can help you avoid these issues and keep your practice running smoothly. Let’s review three of the most frequent compliance mistakes and how to avoid them.
One of the most significant compliance risks in retina practices is a lack of supportive documentation. A chart that does not support the service billed can lead to claim denials or, worse, an audit. Some thoughts to avoid this pitfall include being thorough. The practice can control what is documented.
Take the time to confirm that the chief complaint, exam findings, diagnostic test interpretation and report, medical necessity, and treatment plans are fully documented. Don’t rely on your memory. Document the details during or immediately after each patient visit. Although templates save time, the chart notes should not be identical from one visit to another or from one patient to another. Use templates carefully and edit appropriately.
Some practices assume that they must be compliant if they are getting paid for the claims they submit. However, the question is whether the documentation will support the claims submitted on a post-pay audit. Skipping internal and external third-party audits, such as those conducted by consultants, means potential problems can go unnoticed until an external payer or regulator identifies them.
To avoid this pitfall it is imperative to perform regular internal audits to catch and correct compliance issues before they escalate. Occasionally, use third-party industry-specific consultants for an unbiased perspective on billing and documentation practices. If the practice does not have a compliance program, create one. Create routine reviews for problem areas.
Even if the administrator or practice manager understands compliance rules, there is a risk if the team, including the physicians, aren’t on the same page. A lack of training can lead to errors in documentation, coding, billing, and patient communication.
Some suggestions to avoid this pitfall include providing ongoing training for both new and existing staff members, conducting regular review sessions whenever regulations change or if you notice an increase in mistakes, and ensuring that compliance is an integral part of your practice culture rather than a one-time or annual training.
Compliance isn’t just about avoiding fines and audits—it’s about running a trustworthy, efficient, and financially stable retina practice. By addressing these common pitfalls and implementing robust policies, you can minimize risks and focus on what truly matters: delivering exceptional patient care.
Are you seeking a partner to assist with implementing compliance activities at your retina practice or group? Elizabeth Cifers is certified in Healthcare Compliance and has decades of experience in one of the greatest risk areas for noncompliance: medical coding and billing. She offers consulting, risk assessments, chart audits, training, and more. Book a free 30-minute consultation with Elizabeth here.
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