CMS/HCFA 1500 Claims Analysis
During CMS/HCFA 1500 claims analyses, our certified healthcare professionals perform a confidential review of the patient's medical record, explanation of benefits and HCFA 1500 claim form to identify and assess areas of risk related to coding and billing compliance.
What This Service Includes
Specific areas audited but not limited to are:
- Correct coding of evaluation and management (E/M) services
- Compliance with Medicare E/M documentation guidelines
- Coding laboratory services
- Coding radiology services
- Correct coding and reporting of CPT codes
- Diagnosis codes supported by documentation and supporting medical necessity
- Accuracy of charge tickets, superbills and other forms
- Non-covered services
- Appropriate use of HCPCS Level I and II modifiers
- Provider remittance review
Additional features:
- Focused educational support for coding and medical staff
- Review and trend "medical necessity issues" directly related to the ordering of ancillary services
How You Can Benefit From This Services
CMS/HCFA 1500 claim analyses can improve coding outcomes and support on-going compliance processes. Our educational services ensures that your staff has ongoing training is current billing and coding compliance.