We realize approximately 40% of medical practice income are unpaid due to down coding, missed charges, or not reimbursable. 25% of chart audits uncover coding errors resulting in non-payment. This 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 result as a fraudulent practice. 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 cushion insurance payors denials and suspensions.
Our certified coding audit staff focuses on compliant coding practices as well as on accuracy and quality of coding and physician medical notes. Our dedicate 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 physician, medical billing entities, payers both federal and commercial, county clinics and specialty service providers our experts offer a unique external perspective to the physicians and medical professional with respect to current billing, coding and documentation practices.
Medical notes by the provider are reviewed to determine that the levels of services about to be billed are supported by the providers chart note or dictation. Appropriate use of CPT and HCPCS Modifiers is also reviewed. Upon the conclusion of the coding review and audit, Medical coding team provides post-assessment reports for the practice and for each individual provider with recommendations. Also, a general education session is provided for all providers and each provider receives an individualized educational session to discuss the particulars of their own audit. Our chart review process follows a designed methodology to identify improvement opportunities 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.
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