Such compliance reviews are performed, on-site or off-site via client’s electronic medical record system, for an appropriate sample of patient encounters in the Emergency Room (ER), the Urgent Care (UC), Observation, Ambulatory Surgery (AS), and Outpatient Diagnostic Services. The reviews validate ICD-9/CPT/HCPCS/revenue coding of such services and assess the quality of the chart documentation. The reviews also verify that CPT/HCPCS codes of services per the medical record have been recorded on UB-04 with correctly assigned revenue codes. For the ER and/or the UC encounters, the appropriateness of the Evaluation and Management (E&M) service levels relative to the care provided per the chart, are assessed. St. Clair will conduct, on-site or off-site via a conference call, an exit conference/educational in-service regarding preliminary review findings and recommendations.

A draft of the final report on the review findings and recommendations, with supporting documentation, will be provided within two weeks after the review. Only after obtaining sign-off as to resolution of all hospital questions regarding the review findings and recommendations, will St. Clair issue the final report.

    This review will assess your compliance with the national Correct Coding Initiative (CCI) edit standards and the CMS regulatory standards. This review enhances hospital efforts, through the educational process, to optimize outpatient reimbursement. For one (1) year after the review, at no additional fee, St. Clair provides consultant support, via telephone and/or email, to address any questions about the final report and/or outpatient coding regulatory changes.

    The St. Clair professional fee for an on-site outpatient coding/billing/APC review is competitively priced per record reviewed, plus out of pocket expenses.