Audits and Coding Quality Reviews

The OIG and CMS recommend “regular” coding audits / reviews, but give no guidance as to frequency. We suggest that our clients establish an annual budgetary amount, and then stagger it in quarterly reviews instead of one large annual evaluation. The cost is the same and has three major benefits. First, the expense of the audit is spread throughout the year. Second, the providers and coders receive feedback on the status of the coding throughout the year. Third, a program of regular quarterly feedback provides an opportunity to correct the errors identified and then confirm that the corrective action has been effective without having to wait an entire year. If coding errors continue to occur, then a targeted plan of action can be instituted.

The implementation and operation of this program is quite simple. Periodically (monthly, quarterly, semi-annually, or annually) participating practices send us a representative sample of their visit notes, procedure reports and claim forms. We perform a government-style audit of the coding, using all available screens and regulations. We then send you a case-by-case analysis of our findings. Our medical coding and surgical coding accuracy evaluations are designed to be part of a continuous quality improvement program. It gives our clients’ medical coders and surgical coders the feedback they need to more accurately code the patient-care services.

Have you been the target of a compliance audit? If you think you’re being treated unfairly, let us “audit the auditors.” Our findings can be your best defense!

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Florida AG Arrests Dentist and Office Manager for More Than $50,000 in Medicaid Fraud

February 8th, 2018|Comments Off on Florida AG Arrests Dentist and Office Manager for More Than $50,000 in Medicaid Fraud

Attorney General Pam Bondi and the Pembroke Pines Police Department arrested a dentist and their office manager for defrauding the Medicaid program out of more than $50,000.

Read the full story here.

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Bucks County dentist charged with $1.5M Medicaid fraud

February 5th, 2018|Comments Off on Bucks County dentist charged with $1.5M Medicaid fraud

Ilya Babiner, a Bucks County dentist, was charged Wednesday with 55 third-degree felony counts. Allegedly, the dentist filed a number of claims to the Medical Assistance Program between 2014 and 2016 seeking compensation for $1.5 […]

  • scripps-health

Scripps will pay $1.5M to settle billing fraud case

January 25th, 2018|Comments Off on Scripps will pay $1.5M to settle billing fraud case

Scripps Health in San Diego has agreed to settle allegations it violated the False Claims Act (paying $1.5 million), according to the Department of Justice. This resolves the allegations that Scripps had billed Medicare and […]

  • Orthopaedic-Surgery

CPT 2018 Changes for Orthopaedic Surgery

January 15th, 2018|Comments Off on CPT 2018 Changes for Orthopaedic Surgery

CPT 2018 Changes for Orthopaedic Surgery: It’s all about that Spine……almost

By Heidi Stout, CPC, COSC, CCS-P

 

Not much will change for orthopaedic surgery coding in 2018.  Most of the changes in CPT 2018 to the Musculoskeletal […]