Chart Auditing Service
TCI’s Consulting & Revenue Cycle Solutions works with healthcare providers across the country, helping them uncover both over coding and under coding issues, compliance pitfalls, and missed revenue opportunities. Not only will clients get a complete report showing our detailed audit findings, but you’ll also receive follow-up education to help your providers increase their accuracy and improve their coding confidence.
“You have renewed my enthusiasm for developing new forms and improving my documentation … your information was very helpful.” ~ Consulting & Revenue Cycle Solutions physician client
Typically, we perform chart audits remotely, which allows us to perform a complete audit without disrupting your office’s daily routine. We can work with you to determine the best way to access the records while, of course, ensuring HIPAA compliance.
Our structured three-step approach to every audit will give you the maximum benefits. You’ll receive the following high-quality, in-depth service on every chart we review:
- Coding review — a member of our coding team will review your documentation and determine the appropriate code(s) you should be reporting. We have coding experts in a multitude of specialties, including E/M, general surgery, and primary care, who understand the specialty-specific terminology and clinical nuances that can make coding so difficult.
- Auditor analysis — the next step is a review by one of our senior auditors. By reviewing the coder’s notes and your documentation, the auditor creates a report detailing our findings and providing you with concrete pointers on how to improve your coding accuracy and ensure compliant documentation and coding. We also include the financial impact each error will have on your bottom line.
- Expert education — Finally, once you have had a chance to review our findings, your providers can meet one on one with the auditor or audit team manager. During this education session, you’ll get information specific to the areas for improvement and can also get any additional questions answered. We can teach you both national and payer-specific coding rules, offer tips on how to improve your documentation and templates, provide coding tools to make your job easier, and much more.
Our audit team is made up of certified coders and auditors with credentials ranging from CPMA (Certified Professional Medical Auditor) to CPC (Certified Professional Coder) to CMBS (Certified Medical Billing Specialist) and even specialty-specific coding certifications such as CUC (Certified Urology Coder) and CPEDC (Certified Pediatrics Coder). With the unmatched expertise of our team, your providers will receive the follow-up education that will help you shore up your coding before a payer comes knocking on your door.
"The Coding Institute's services and publications have been fantastic. Their timely newsletters are always filled with incredibly useful and include important, detailed, and clear information that is imperative for both my work and my fellow employees. I have spoken with numerous others who highly recommend the consulting service since it is both reliable and a great help with various frustrating problems they have faced." ~ Olivia Papa, Cambridge MA
To ensure you get the highest level of service and accuracy, we also perform random quality checks on a percentage of every client’s charts. This additional stage of review helps ensure you are getting detailed, accurate, and useful reports.
While we find this three-step approach typically works best, we can also tailor the process to the individual healthcare entity to provide the information and education your providers need.
You can choose from four audit services:
- Prospective Audit – Our expert coding team will take a look at your claims, pre-submission, to ensure that your claims are accurate, compliant, and denial-proof.
- Retrospective Audit – Our coding experts will review your claims and documentation history to identify areas for improvement in your coding, billing, and documentation practices.
- Focused Audit – During a focused audit, our highly skilled coding team will review your claims history in search of specific areas identified by your organization as trouble areas.
- Corporate Integrity Agreement (CIA) – Has a Medicare contractor identified problems in your coding practices? We can help! Our AAPC specialty-certified coders will delve into your medical records and help you correct problems identified by Medicare contractors.
Don’t see what you need? Let us know. Chances are, we can help!
Schedule your chart review today and take the first step toward more accurate, more compliant, and more successful coding.
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Chart audits provide practices with a snapshot of documentation, coding, and billing accuracy. They are a key tool in helping you improve your billing accuracy and increase your overall profitability. Further, audits can reduce billing mistakes that may result in a payer or government audit by uncovering your areas of deficiency, and then your practice can actively correct the errors and discrepancies.
Consequences: Without regular auditing, you could be making coding and billing mistakes over and over again. And if a payer or government auditor finds those problems, you might have to refund thousands of dollars and face further penalties and fines.
Financial impact: You may think that down coding claims is only costing you a small amount of money per year, but even under coding just one level means you are likely leaving a massive amount of money on the table over the course of a year.
For example, if your physician’s documentation justifies billing a level-four new patient office visit (99204) but she down codes it to a 99203 because she isn’t confident that she has adequate notes to bill the 99204, you’ve just forfeited about $56.00, which is the difference in average reimbursement between the two codes. If just one physician at your practice does this twice a day over the course of a year, you’ve written off nearly $30,000 annually.
TCI’s Consulting & Revenue Cycle Solutions can help educate your providers so you don’t lose hundreds of thousands of dollars each year!