We understand that a sizeable percentage of medical practice claims are unpaid due to down coding, missed charges, or not reimbursed due to other reasons. 25% of chart audits uncover coding errors resulting in non-payment of claims. Frequent coding errors can result in inspection by payors such as Medicare and result in your practice being audited for over coding and for down coding of services. Both can be treated as fraudulent practices. ICD-10-CM and CPT coding audits help physicians and medical practitioners of all sizes to appropriately assign procedure codes, reduce over coding and down coding liability, and bring down payors’ denials and suspensions.
Our certified coding audit staff focuses on compliant coding practices as well as accuracy and quality of coding and physician medical notes. Our dedicated team consists of certified professional coders who bring the most value to your facility. With over +65 years of cumulative medical reimbursement expertise, having worked with physicians, medical billing entities, payors both federal and commercial, county clinics and specialty service providers, our experts offer a unique external perspective to medical professionals with respect to current billing, coding and documentation practices.
Medical notes by the provider are reviewed to determine that the services about to be billed are supported by the providers chart notes or dictation. Appropriate use of CPT and HCPCS Modifiers is also reviewed. Upon the conclusion of the coding review and audit, the medical coding team provides post-assessment reports to the practice and to each individual provider with recommendations. Also, a general education session is conducted for all providers and each provider receives an individualized educational session to discuss the specifics of their own audit. Our chart review process follows a designed methodology to identify opportunities for improvement through a comprehensive assessment of medical notes, coding, and billing. This approach identifies gaps between existing processes and national best practices: We specialize in all aspects of professional coding audits.
We offer the following services
- Coding and Billing Audits
- Medical Coding service
- Onsite coding service
- Remote coding service
- Revenue Cycle Management
- Denials Management
- Pre-billing Edit Reviews
- Medical notes Improvement Consultations
- HCC and HEDIS coding and review
Talk to us today to discuss how our coding and documentation audits could benefit your practice.