Chart Auditing

In spite of the inherent complexities, it is critical that your coding and billing process produce claims that are accurate and supported by available medical documentation. When payers identify inaccurate claims they typically demand refunds of inappropriately reimbursed money and often assess penalties that can range from three times the inappropriately billed amount to fifteen thousand dollars per claim and sanction from participation in Medicare.

The level of penalty assessed in false claims cases is usually “culpability-based.” This means that if inappropriate coding is systematic and the result of reckless disregard for applicable rules the most substantial penalties are applied. However, if the practice can illustrate that it made whole-hearted efforts to follow the applicable rules and that the inappropriate coding was unintentional, minimal penalties are typically assessed. We approach each audit project with the goal of Compliance And Revenue Enhancement. We strive to commend accurate documentation and coding when identified. We match each identified concern with an explanation of the applicable regulations and best practice guidance that will minimize recurrence of the concern in the future.

We follow the audit process and standards used by Medicare fraud and abuse contractors. This approach provides you with three key benefits: you will have the opportunity to correct any identified concerns before payer auditors identify the concerns, we will establish proof of a whole-hearted effort to comply with the applicable rules, and we will screen to confirm that all of the charges you are entitled to are captured in the billing process. Projects like this frequently identify under billing and un-captured charges that more than pay for the cost of the project. Corrective actions to address the identified concerns will allow you to enjoy this return on investment several times over in the coming years.

At the conclusion of your audit project, your physicians will receive patient-by-patient findings and recommendations for each audited service. We also provide graphical summaries of audit findings at the physician and the practice-wide levels. Executive copies of the audit reports and practice wide comparisons of audit performance are also provided to your designated administrators.

Don’t put it off any longer, have a representative audit of your procedures and visits conducted now.  The fee is generally $100 per audited service but discounts are offered projects that include more than 100 visits/procedures.  E-mail me (jim@cardiologycoder.com) for a personalized quote and to learn more about this important service.