Billing Practice Auditing
"Advocate. Market. Elevate."

An increase in the government auditing of health care provider billing practices has cost providers considerable time and energy, not to mention large fines. We can audit your billing practice, including your procedural coding, to maximize reimbursement and help avoid potential governmental audits.Systems_Checklist

We will help you to:

  • Meet staffing challenges head on and determine if the right staff are doing the right things at the right time.
  • Create a synchronized, patient-focused, innovative care team that works to support both the physician and the patient.
  • Optimize back-end billing and business processes to enhance revenue, including account follow-up, payment posting and denial management.
  • Recognize and use key billing benchmarks for improved collections.

Whether you’re looking for a simple 20-record chart audit or you need a comprehensive evaluation of your revenue cycle, we can help.

When was the last time you validated your physician’s coding and documentation? How do you compare?

Every Chart Audit Includes

  • A quality review of each chart’s documentation and coding by a certified professional medical auditor.
  • A detailed audit report of the findings along with recommendations and cross references to coding guidelines.
  • A consultation with your providers and staff to review the audit report and provide training and education based on the findings.

At a minimum you may be losing revenue due to improper coding of documentation not supporting the level and scope of care provided. Worse, you’re exposing your practice to tremendous financial risk.

How we can help your practice:
We provide a full range of audit services designed to help you strengthen the financial health of ur practice and inoculate you from the risks of audits.

Chart Reviews:
Evaluate the accuracy of your current documentation and coding.

Our chart review process follows a structured methodology designed to identify improvement opportunities through a comprehensive assessment of documentation, coding, and billing. This approach identifies gaps between existing processes and national best practices:

  • Step 1 – Auditor assigned

An auditor will be assigned to your project by matching the expertise of the auditor with your specialty.  All auditors used by MedPro are certified who have passed rigorous testing and qualification requirements.

  • Step 2 – Chart review performed

Chart reviews are typically performed remotely.  We will work with you to identify the most appropriate method to obtain access to those records selected for the review.

  • Step 3 – Review by a senior auditor

We will review and validate each chart audit, including the audit findings and recommendations. This multi-layer review provides further validation that your audit findings are complete and accurate.

  • Step 4 – Report of Findings

Each chart review includes a detailed written report listing errors identified during the audit, potential utilization issues, and potential financial impact.  Reports will also include documentation tips and improvement recommendations based upon the audit findings.

  • Step 5 – Training

A consultative meeting to review the results of the audit report, discuss key findings and provide education and training on identified areas needing improvement.

Under Coding Impact

The following is an example from a clinic of 18 primary care providers with an average clinician FTE of 0.8

Annualized utilization of 99214 = 6,789
Utilization after chart review and training 99214 = 9,780
Difference = 2,991 X $34 = $101,694

EMR Coding / Documentation Review:

Evaluation of the impact your EMR is having on your coding and documentation.

EMR’s are providing many benefits for medical documentation, however, because of the complexity of coding, most EMR’s are still not able to accurately code based on the information entered.  For many physicians, our audits are bringing to light coding risks they were not aware of and inefficiencies they are happy to get help with.  Our experts will review your templates and final documentation and then provide education and advice to maximize efficiency and accurate results.  With so much focus today on “meaningful use” we focus on profitable use of your EMR.

ICD-10 Assessment:
Assessment of existing documentation to identify deficiencies in preparation for ICD-10-CM.

One of the largest problems following the October 1, 2013 implementation date for ICD-10 will be documentation insufficient to support the specificity required for the new ICD-10 code sets. We are concerned this has been forgotten among the other education, training, and implementation objectives. If the office is fully prepared for ICD-10, but clinical documentation has not improved, accurate coding and proper payment will not be possible. We believe a behavioral change in documentation habits for most providers will be necessary—and now is the time to start preparing.

A clinical documentation evaluation will:

  • Validate sufficient ICD-10 documentation
  • Identify ICD-10 clinical documentation deficiencies.
  • Identify ICD-10 training specific to your needs.
  • Avoid an increase in denied or unbillable claims.
  • Prevent an interruption in revenue.

Appeals:
Assistance with navigating the appeals process and collecting money related to medical necessity. Let our team of experts help you get paid for the work you perform.

Providing services and not being paid is perhaps one of the most frustrating things providers face. But did you know that just because you were not paid on the initial determination does not necessarily mean you shouldn’t have been paid? Let our Audit Services group evaluate your denials and help you through the appeals process so you can be properly paid for the services you’ve performed and documented.

Educational Services:
Services and resources from our professional trainers to help educate your physicians and staff.

As part of each of our audits, we provide feedback to you on our findings and what you can do to improve outcomes. But you may want more formal training on best practices in documentation and coding. We work with you to help you understand how to document better, not document more. Better documentation leads to better coding and subsequent reimbursement.

Corporate Integrity Agreement (CIA) Audits
If you’re required to contract with a third-party for independent audits, we have the necessary certified coders available to meet the Office of Inspector General’s requirements to meet your annual reporting needs.

Are you under a mandatory CIA imposed by the government? Are you required to work with an independent entity to perform audits for your services? The Audit Services group has the necessary certified coders available to meet the Office of Inspector General’s requirements to meet your annual reporting needs.

Audit Validation
Internal audits are a great way to demonstrate your efforts to submit complete and accurate claims to payers. But there may be times when you want to be sure that others outside your practice would agree with the findings of your staff.

Internal audits are a great way to demonstrate your efforts to submit complete and accurate claims to payers. But there may be times when you want to be sure that others outside your practice would agree with the findings of your staff. External audits performed by the Audit Services group can validate the findings of your staff and provide further evidence of the accuracy of your current documentation, coding and billing practices.

Contact us to schedule a no obligation consultation to assess your needs and determine how we can help your organization.