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.
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Observation status
New guidelines on calculating time for observation, as well as difficult-to-understand coverage guidelines, make observation a perfect target for the new permanent RACs. Our experts will analyze the current regulatory environment related to observation status and help you determine the appropriate patient classification. Reimbursement dollars are at stake! Learn more about our December 12 audio conference.
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CPT 2009
Do you have time to make sense of the hundreds of new CPT code changes for 2009? Our experts do. At the end of this live audio conference, your staff will be able to identify which sections of the 2009 CPT Manual saw the greatest number of revisions, demonstrate how and when to use the new CPT codes and explain the rationale for the changes. Learn more about our December 2 audio conference.
