A certified professional performs a confidential review of the patient's medical record and explanation of benefits to identify and assess areas of risk related to coding and billing compliance. Some areas of attention 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.
The primary benefits of these services are to identify opportunities for improved coding outcomes and for support of on-going compliance processes.
