A robust snapshot through detailed auditing


We offer medical coding audits that are designed to give you an accurate picture of where your facility stands in regards to all facets of coding accuracy. Now more than ever it is critical to identify and subsequently rectify coding errors before they are discovered by someone like a RAC.


The sample of the ED audit includes:

  • Verification of ED level of service assigned for facility services
  • Verification of ED level of service assigned for physician services, if applicable
  • Verification and identification of all procedures performed and reported by ED facility and/or physician staff
  • Verification of ICD-10 Diagnosis code assignment, including Principal and Secondary Diagnoses
  • Medical Coding and Documentation Education
  • Verification of coding for medical necessity

 

Based on the audit results, information is presented to provide:

  • Average level of service as coded by your facility, both facility and professional
  • Average level of service as coded by HCCS, both facility and professional
  • Average charge per patient as billed by your facility
  • Average charge per patient if HCCS had coded the ED charts
  • Analysis of documentation practices
  • Analysis of coding, both ICD-10 and CPT
  • Appropriate use of modifiers
  • Comprehensive comparative analysis of facility and professional charges
  • Financial analysis of facility coding compared to HCCS Coding
  • Analysis of facility billing practices, including price structure

These errors are much more common than many believe and the presence of any one of them can be too much to ignore from a compliance standpoint and is indicative of under-coding that can amount to tens, if not hundreds, of thousands of dollars in lost revenue each year. Finding a few hundred thousand dollars in entirely legitimate, yet unrealized revenue at a facility is a discovery of these audits that is not at all rare. This is the product of accurate coding, and is why our company standard of 95% accuracy is so important. 

 

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