Medical Coding and Review of Charts
All physician chart audits are not the same. Charts can be reviewed for documentation to support the code billed, medical necessity, supervision or presence requirements and correct coding. All services described below ase performed by Certified Procedural Coders with over 8 years of professional review experience. There is one initial comprehensive review backed by quarterly audits.
The patient's chart will be pulled to review the accuracy and the validity of the CPT, HCPCS, Modifiers, and ICD-9 codes billed as compared with the physicians chart notes for the encounter.
A list of major items to be considered follows:
- Sampling of 20 - 30 patient encounters per each provider
- Services that do not possess “medical necessity” (ex. Local Medicare Review Policies)
- Were the appropriate provider numbers utilized?
- Non-Covered Services.
- Duplicate Billing – submitting more than one claim for the same service.
- Up coding for services performed.
- Unbundling of services; if applicable.
- Submitting claims for services that were not provided.
- Waivers signed “Advance Beneficiary Notice.”
- Preventative Medicine vs. Routine Office Visit.
- Medicare's Policy on the three-day window; if applicable.
- Consultation vs. Referral.
- “Incident to Rules” for midlevel providers; if applicable.
- “Assumption” coding.
The information will determine if the group is over-coding or under-coding and provide a financial impact to the group. Findings will be consolidated in a written report, which will be presented to the provider.
Benefits:
On average, the physicians practice may be consistently leaving money on the table due to coding and charge capture errors!!! Our strategies improve the bottom line through correct coding. Avoid under coding by learning to document and bill correctly. Uses the National Correct Coding Initiative (NCCI) edits correctly and apply modifiers accurately to get paid the maximum allowable amount for the services provided. We will discuss ways to keep up-to-date on coding and government regulations to maximize practice revenue. But chart reviews serve another function, as well. Plenty of the coding mistakes picked up in reviews cost practices money, resulting in lower reimbursements than they're entitled to.
- Now that PayD System is working for you, your risk on getting paid will be reduced by 30% or better.
- Your overheads will be reduced by at least 25%.
- Compliance with current regulations ($10 – 15K / Year / Physician).
- Reduction in Up-coding and Under-coding (Under-coding costs 8 – 13%).
- Better control of your practice.
- You can focus more on what you enjoy (your patients).
- Inadvertent billing mistakes may lead to an audit from the Medicare, fines, and, even worse, investigation from the Office of Inspector General (OIG), the federal office charged with enforcing health care fraud and abuse laws.
