Audit

Auditing is a key element of any compliance program. Retrospective chart assessments serve to identify current problems, training requirements and opportunities for improvement. PCS evaluates the reliability of the coding and medical record documentation for professional component charges to ensure appropriate reimbursement from Medicare and commercial payors. We identify potential compliance risks. Post-audit findings are used as a baseline for measuring improvement and to provide data for customized training seminars. Our review incorporates accuracy, specificity and medical necessity.

A random or focused sample of medical records is reviewed for accurate documentation supporting the selected level of Evaluation and Management (E&M) codes and the accuracy of ICD-9-CM, CPT/HCPCS coding in the same way Medicare audits a chart. The assessment measures data quality that drives the appropriate reimbursement for services rendered. Additionally, the audit revels potential opportunities for improved procedure coding.

Features include:

ØReview of all documentation for the specified E&M visit,
            including related reports/procedures

ØReview of ICD-9-CM, CPT/HCPCS coding, and specific
            modifier selection for specified services

ØAssessment of billing flow from charge ticket to CMS-1500
            completion and EOB receipt, as it pertains to each encounter

ØAssessment of all supporting documentation for a variety of
            physician-type visits (i.e. inpatient/outpatient)

ØEvaluation of compliance with Medicare coding and reporting
            guidelines

Benefits include:

ØSpecific recommendations that address documentation and
            coding processes

ØIdentification of improved mechanisms for collecting
            information critical to patient care, coding, reimbursement
            and compliance

ØProvide and assist with the implementation of ICD-9-CM and
           CPT/HCPCS specific documentation tools

ØExperts in the health care and coding industry perform all
            services

Return on Investment:

ØObtaining reimbursement to which you are legally entitled

ØAvoid penalties with complete compliance through
            identification of issues in the post-audit conference

ØCapture revenue sooner by building quality into the
            reimbursement process and eliminating inquires and
            re-billing activities

ØIncrease productivity of reimbursement staff by reducing
           denials and wasted time researching them

PCS includes in this service a post-audit conference to review the assessment findings, along with providing a comprehensive written report summarizing the types of errors, impact on reimbursement and recommendations for improvements. Additionally, we include a maximum of two (2) hours of educational training/seminars based on audit results, and a follow-up focused, five (5) record audit in 3 month to assess the implementation of post-audit recommendations.