Auditing Services

Review of physician office / clinic physician notes, ICD-10-CM diagnosis and CPT procedure codes for professional fee billing.
 

Review of provider’s documentation to identify areas of documentation likely to impact reimbursement which could result in increased queries and delayed billing.
 

Claim Review and Appeals - offers support in preparation, education, trending, case review, preparation of appeals, and tracking. Identification areas of risk leading to upcoding or down coding in the documentation and medical coding accuracy.
 

Verification that coding practices are compliant with the regulations set forth by private and government payers.
 

Education of providers and staff on how to use documentation to maintain HIPAA compliance.
 

Complete Chart Audit.
 

EMR Coding/Documentation Review.
 

Review compliance with the Incident to guidelines and services performed on collaborative premises.
 

Analysis of Denials/Duplicate billing /Appeal process (Pre-payment and Post-payment)/Modifier usage.
 

Review of format and content of the health record as well as other forms of medical/clinical documentation.
 

Coding review, including ICD-10-CM, CPT, HCPCS.
 

Analysis of billed claims, including the UB-04, the HCFA 1500, charging procedures.
 

Review compliance with the State and federal regulations concerning the use, disclosure, and confidentiality of all patient records.
 

Front Desk work review including but not limited to: Eligibility verification/Benefit maximums verification/Excluded services verification/Authorization process/Patient responsibility (deductibles, copays, coinsurance)/Coordination of benefits.
 

Review billing practices for compliance with applicable federal and State fraud and abuse statutes and regulations..
 

Insurance plans participation and consistency of contracted rates.