Physician Practice Coding Review
Process
Physician Practice coding reviews are performed, on site, to validate the medical record ICD-9/CPT coding and assess the quality of the supporting documentation for an appropriate sample of selected patient charts. The ICD-9/CPT codes of the services indicated in the medical record are compared, for accuracy purposes, with the CMS1500 billing forms. For each flagged coding change, there is provided a relevant references and citations and markings of supporting documentations in the medical chart. For clinic and emergency room encounters, the appropriateness of Evaluation & Management (E&M) service levels are assessed relative to the clinical documentation in the medical record. We also check for proper use of E&M and surgical modifiers, bundling/unbundling of services, and proper billing of modifiers. An exit conference is conducted, with Management of the Physician Practice, regarding the preliminary coding review findings and recommendations. Also, an education in-service is held, with the Medical Records coders, as to the review findings.
Benefits
The review takes into consideration compliance with the CCI edit standards and the CMS regulatory standards. The review is financially beneficial by identifying physician practice underpayments as a result of inaccurate CPT assignments, avoiding delays in practice payments due to improperly coded claims being rejected or denied, and minimizing risk of audit under healthcare fraud and abuse regulations. For one (1) year after the review, at no additional fee, St Clair addresses, via telephone/fax or e-mail, any questions about the impacts of regulatory changes upon physician practice coding.
Pricing Approach
The St Clair professional fee for an on-site physician practice coding review is competitively priced on a "per record" basis, plus out of pocket expenses.