Medical Auditing for Health Care Facilities and Physician practices is a key to being compliant and profitable. Hospitals reported $167 Million by Recovery Audit Contractors (RACs). We can help your practice make sure your documentation includes the correct modifiers, evaluation and management codes and procedures that support medical necessity.
Benefits of An Audit by Precision HealthCare Consultants
- Discover and take action against coding and billing errors to prevent governmental investigational auditors, like Recovery Audit Contractors (RACs)
- Help protect your practice against fraudulent claims and non compliant billing activity.
- Uncover and remedy under-coding and money left on the table!
- Identify and correct instances of inappropriate billing of services appropriately provided and documented.
- Diagnose reimbursement deficiencies and opportunities for appropriate reimbursement.
- Eradicate the use of outdated or incorrect codes for CPT Codes/procedures.
- Decipher and eliminate unbundling and over utilization of codes, which can lead to audits.
Scope of Work for Providing Audit For Your Facility/Practice
Package #1 – Starter Audit – (3 Case/Encounter Review) $449
Package #2 – Pro Audit – (5 Case/Encounter Review) $699
Package #3 – Executive Audit (10 Case/Encounter Review) $999
Custom Package – Let’s Talk to Customize Package for Your Practice – Call us @ 516-771-7554
All Packages Include The Below Scope of Work:
- Defining the scope of your audit – Number of Cases and Insurance Carriers.
- Utilize the following reference materials:
- Current editions of coding manuals
- National Correct Coding Initiative (CCI) edits
- Center for Medicare & Medicaid Services (CMS) policies and/or other third-party policies.
- Verifying the accuracy of billed services by obtaining copies of electronic or paper claim forms and encounters
- Validation of:
- CPT® code use
- Level of E/M visit
- Review of under-documented or undocumented services
- Correct modifier usage
- Accuracy of diagnosis codes
- Source documents supports medical necessity.
- Review of basic compliance items:
- signatures and authentications of physicians and/or providers
- patient identifying information
- incident-to requirements compliance
- Prepared summary of findings and recommendations
- Scheduling meetings with the physicians and/or office administrator to review and provide findings along with recommendations for optimal reimbursement
- Suggest/Propose training along with process to monitor the identified areas after addressing the issues.
Our team of AHIMA and AAPC Certified Inpatient, Outpatient, Evaluation & Management and Procedure Coders and Auditors have helped doctors and facilities ensure compliance and identify any areas of clinical documentation deficiencies along with potential reimbursement under-coding where money is left on the table.
Our Auditors are certified with AHIMA and AAPC to provide the following services:
- Insurance audit appeals
- Coding and billing accuracy
- Accounts receivable audits
- Compliance audits
- ICD-10 compliance with our AHIMA ICD-10 Certified Trainers