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Typically,
we will review from 3 to 30 charts per practitioner. The charts will be reviewed by our
certified coding and health information experts for the
following:
-
Compliance
with Centers for Medicare and Medicaid Services (CMS)
and specialty documentation guidelines.
-
Comparison
to hospital records (if available).
-
Clinical
abstracting and data collection methods Correct ICD-9 and CPT coding.
-
Compliance
with Centers for Medicare and Medicaid Services (CMS) National Correct Coding Policy System for capturing
charge data.
Most chart
audits can be done remotely. We prefer an equal number at:
|
30 days Date of
Service |
|
60 days Date of
Service |
|
90 days Date of
Service |
Each
audit should contain the:
-
Doctor's
notes
-
CMS
1500 Form
-
Fee
Ticket
-
EOB's
if available.
Our
certified coders will provide an in-depth analysis of coding and billing
techniques to identify deficiencies and potential opportunities for
future revenue enhancement. A complete report will be provided with
specific analysis of each encounter reviewed.
|
¨ Unspecific
ICD-9 Codes |
¨ Codes
not age appropriate |
¨ Coding
for deep tissue repair. |
¨ Unbundled
Codes” |
|
¨ E
Code Usage |
¨ Level
4 & 5 Visits |
¨ Upcoding |
¨ Downcoding |
|
¨ V
Code Usage |
¨ Modifier
– 50 |
¨ Modifier
– 52 |
¨ Inappropriate
Codes |
|
¨ Modifier
– 26 |
¨ Modifier
– 51 |
¨ Modifier
– 90 |
¨ Modifier
- 25 |
|
¨ Improper
use of “After Hours” codes |
¨ Improper
use of consultation E & M codes. |
¨ Incorrect
units of service for injections |
¨ Injection
Administration Codes |
|
¨ Correct
Use of HCPCS codes |
¨ ICD-9
& CPT linking |
¨ Documentation
Errors |
¨ Documentation
Omissions |
|
¨ Missing
EKG report |
¨ Proper
coding for supplies |
¨ Late
Effects coding |
¨ Medical
Decision Making |
|
¨ Lack
of appropriate History
|
¨ Nature
of Presenting Problem
|
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We
review the claims for timeliness, completeness and enclosure of
appropriate attachments when necessary. We will evaluate the procedures
for follow-up of unpaid claims and resubmission of denied and rejected
claims. We review invoices from labs and medical supply companies in
order to determine if these charges are being captured properly. The
desired result is reduced claim rejections and denials, more "clean
claims," improved cash flow, and appropriate reimbursement.
As
part of our evaluation process, we will review the current superbill/charge
ticket being used in each clinic and will analyze the procedures for
collecting and verifying patient personal and insurance data and make
specific recommendations as necessary.
At
the conclusion of our review, we will hold an exit conference with the
physicians and staff to address findings, conclusions, and make specific
recommendations. We will review the principles of documentation and
provide guidance to help the physicians develop a clearer picture of the
information the insurance companies, particular managed care companies,
and Medicare/Medicaid require. We then show how the documentation
determines the level of service selected for the encounter and provide
pointers for increasing levels of service and revenues. We also show
ways in which more comprehensive documentation allows the staff to
select a more specific ICD-9 code as required by Medicare and private
insurance carriers. We also discuss any legal or risk management
problems identified.
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