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!

Latest Blog Posts:

  • mitchell-and-residents-730x564

Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

November 5th, 2017|Comments Off on Utah Pain Doctor and Medical Practice Settle Medicare Fraud Claims

On July 21st, 2017, Jahan Imani, M.D., and Intermountain Medical Management, P.C., (IMM), a Utah based pain management specialist and his practice, entered into a $399,895.92 settlement agreement with OIG. This resolves allegations that IMM, […]

  • New York Spine and Wellness Center

Syracuse Area Medical Practice Improperly Billed for Moderate Sedation Services

November 1st, 2017|Comments Off on Syracuse Area Medical Practice Improperly Billed for Moderate Sedation Services

New York Spine and Wellness Center (under the umbrella of New York Anesthesiology Medical Specialties, P.C.) agreed today to pay $1,941,850.29 to resolve allegations that it improperly billed for moderate sedation services.

Read the full story […]

  • wachler-associates

Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

September 5th, 2017|Comments Off on Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

An announcement came back in back in October 2016 from the Centers for Medicare & Medicaid Services (CMS). It announced that it had awarded to various entities the next round of contracts to serve as […]

  • GenericFraudHFN_27

Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million

September 1st, 2017|Comments Off on Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million

Along with 14 of its member shareholders, Fredericksburg Hospitalist Group has agreed to pay nearly $4.2 million to settle a federal False Claims Act case brought under the qui tam whistleblower provisions of the FCA.

Read […]