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Chart, EHR Template & Billing Audits

Learn how to survive to a Medicare Audit

What is a Chart Audit?

A chart audit,  could be initiated by Medicare and other third-party payers and documentation would be requested for many reasons (i.e., randomly; as a result of a CBR [Comparative Billing Report] where you fall outside of the “norm”; patient complaints about your billing; too many hours in a day, etc.). 

Not every chart audit results in having to pay money back to Medicare or other third-party payers…. but, many do.  In addition, to your, possibly, being flagged (Prepayment Review); whereby, documentation would be required prior to your being paid.

You can be proactive by conducting an internal or external chart audit to ensure your documentation would “past muster” if Medicare or another third-party payer does request copies of your medical records.

Areas of concern:

Are your telehealth visits appropriately documented?

Is the level of care being billed, the level of care documented?

Does the documentation support the medical necessity of testing or procedures, and, even the visit?

Are procedures, for which, many are considered minor surgery (i.e., ear lavage, excision, injections, etc.) correctly documented?

For procedures and services that are “time-based”….is the time (number of minutes), in addition to a description, being documented?

How we can help you?

Your patients need an ANNUAL WELLNESS VISIT….and, so do YOU.

Our “Annual Wellness Exam” (Chart Audit) will ensure:

Documentation supports the level of care

Proper coding for the location of services being provided

 The, actual, medical necessity of the visit is documented

Procedures and testing are appropriately documented to support medical necessity

“Pre-requisites” are documented (i.e., 3 months of conservative treatment, etc.).

Identification of missed coding opportunities

Proper signature requirements are being met

General documentation requirements (i.e., patient’s name and identification on each and every page)

Knowing if just an “interpretation” is needed or is the hard copy only required

Incident to services are in compliance with Medicare’s regulations

A chart audit will give you peace of mind that your documentation will survive a Medicare audit.

Even when you receive a Comparative Billing Report (CBR) that your coding falls outside the norm of your peers.

EHR Template Audit

In many ways, EHR Systems have transformed the delivery of healthcare,
but it only “works” if it is aligned with current payer requirements.

Ask yourself (or better yet, ask US)…

Do your medical records look like they are being “cloned”? (This has been flagged as an audit trigger by the OIG)

Is the patient presenting with “no chest pain”; however, you are ordering a diagnostic test for chest pain?

Are you using history and physical examination as two of the required components to support a follow-up visit, when the medical necessity of performing a new history is not indicated?

Are you assuming your PLAN reflects that a procedure and/or diagnostic testing is, actually, being performed?

Do you believe that “all 14 systems negative “ supports” a complete Review of Systems”?

History and physical examination can, easily be coded by EHR… but, how is the medical decision making being coded?

 Is the level of service indicated by your EHR… really the appropriate level of service?

We will supply the necessary human intelligence to ensure your EHR system and those that use it are maximizing reimbursement potential, as well as minimize the risk of denials and audits.

Medical Billing Audit

Along with our partners at Professional Reimbursement Managers (PRM),
we will make an assessment of your current billing situation to determine where you may be losing income or putting yourself at risk.

Specifically, we will:

Review billing performance and identify specific billing and coding issues.

Review accounts receivable collection performance and recommend opportunities for revenue enhancement.

Compare key performance indicators such as contractual adjustments, bad debt, and refund balances to industry benchmarks.

Identify areas of potential non-compliance.

Evaluate whether documentation and coding is appropriate and in accordance with applicable governmental and third party payer billing requirements for the state in which the practice operates.

Recommend applicable methodologies for ongoing billing operations and specialty specific compliance monitoring (optional)

Upon completion, we will provide you with a written analysis and recommendations.

Learn More about Diagnostic Services

Hourly Consulting

Chart, EHR Template & Billing Audits

Denial Management and Audit Prevention Planning