Billing and coding audits

Our team can provide insight and expertise for all of your coding needs: inpatient or outpatient, facility or physician. We can help you with the following:

Evaluation and Management

• Physician E/M: Conduct audits using 1995 or 1997 guidelines
• Facility E/M: Ensure compliance with CMS’ 11 criteria for E/M development
• Facility E/M: Review and recommend changes for current policy and procedure for E/M development
• Facility E/M: Review charge capture model

Documentation

• Review documentation against charges to ensure appropriateness and accuracy of coding (for physicians and facilities)
• Ensure all appropriate documentation is present for accurate coding of infusions and injections
• Verify all procedures are adequately documented to receive earned reimbursement

Outpatient coding

• Ensure all applicable modifiers are appropriately appended
• Ensure that CPT/HCPCS codes are based solely on documentation
• Make certain chargemaster driven codes are accurate
• Verify your organization is meeting all current coding guidelines
• Charge capture: ensure that claims submitted are accurate and comprehensive and include all charges for services rendered

Inpatient coding

• Ensure all appropriate documentation is present to support charges
• Review coding against AHA coding clinic guidelines
• Ensure criteria for inpatient admission has been met
• Ensure all documentation is required to ensure all MS-DRG assignment of CCs and MCCs are accurate
• Review current physician query process

We can also develop on-site customized education.

Send us a query.

• RAC Readiness

  

  Despite a delay because of contractor protests, RACs are inevitable, and the burden now falls on your facility to protect your reimbursement dollars. Discover tips and strategies to combat denied claims. Learn what to expect when RAC comes to your state, how to track your RAC claim process, craft an appeals process, select your RAC team and avoid denials in the first place. Learn more about our January 6 audio conference.

• Injection and Infusion Coding and Billing

  

  Many hospitals continue to struggle with reporting injection and infusion services accurately and completely. Issues such as reporting start and stop times, selecting the initial service, and dealing with Medically Unlikely Edits are just a few of the issues with which hospitals still struggle. Our speakers will share what they consider to be best practices for documenting infusion time, reporting drug administration services that cross the midnight hour, and charging for services in the inpatient and outpatient setting, among others. Learn more about our January 20 audio conference.