Medical Coding Audits and Compliance
Coding Audit Services to optimize reimbursement
Accurate coding by Physicians is critical to getting paid for the services provided and for avoiding external audits by Medicare and other Payers. The easiest and probably best way is to audit a select sample of charts. RevenueXL provides medical coding compliance and coding audit compliance and regulatory services to physicians which enables them to make corrections before their coding is challenged by the payers. Our coding audit services are designed to help your compliance with different industry standards. Our coding audit services also enable the providers to fully code the encounters which may be otherwise be down coded.
Coding Audit Process
- Select 10 to 15 charts for each Physician
- Ensure that you select several of each E&M service chosen (New patient, Established patient, Consultation, etc.)
- Do not select old services (more than 3-4 months old)
- Include all supporting documentation
RevenueXL utilizes current AMA and industry coding guidelines, Correct Coding Initiative edits, CMS/Medicare LMRP's and all recognized specialty specific coding conventions and practices. Our medical coding audit services also includes a case-by-case analysis of our findings. Our medical coding accuracy evaluations are designed to be part of a continuous quality improvement program. It gives the providers and surgical coders the feedback they need to more accurately code the patient-care services.
All physicians, surgeons, hospitals and ambulatory surgical centers need accurate medical coding and surgical coding for proper payment, but specialists are most acutely in need of precise coding to optimize their collections. In order to perform a complete audit of the surgery in question, RevenueXL will require the billing record (CMS 1500 form), along with the operative report to make the determination.
Coding Audit and Compliance Solution
- Review for improper use of CPT codes
- Review for proper place of service
- Missing modifiers and / or incorrect use of modifiers
- Incorrect diagnosis which does not indicate medical necessity
- Reviewing Operative Reports and identifying coding and documentation accuracy, trends and deficiencies (if any) by provider.
- Identify whether the extent of documentation is adequate to describe procedure
- Identify any bundling or cluster issues (CCI edits and LMRP)
- Provide recommendations based on audit findings
If you want to determine whether the services billed were reasonable and necessary, we will require the entire patient chart, including history and diagnosis.
Benefits of our Coding Audit and Compliance Services
- Lower rate of claim denials and rejections
- Optimized collections since claims are now coded to the right level
- Improves compliance with your coding guidelines and regulations
- Meets OIG requirement for at least annual auditing of coding
- Assists in education and training of physicians and other coding staff
So why not contact us today for your Medical Coding or Coding Audit requirements for your practice by simply completing our Free Demonstration Form.
Our practice, IMS, was not sure if coding audits were needed for the practice. RevenueXL offered us our first month free so that we could ease into their coding audit service. Today, we are so glad that we gave them a chance! Their staff is knowledgeable and professional- something that makes our coding education easier because they truly understand the coding compliance business. I am impressed with RevenueXL's speed, comprehensiveness and educational aspect. They have helped me code more accurately. They offer outstanding customer service and support, and there is no other company we would trust in completing our monthly coding audits.