Outpatient Coding/Billing Review

Process

A St. Clair Senior Consultant performs such a compliance review 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 revenue codes of such services and assess the quality of the chart documentation. 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.

In the course of performing the review, St. Clair drafts a “claim by claim” Excel spreadsheet regarding its findings and a narrative report which are forwarded for client review prior to an exit conference on-site or off-site via telephone.  After obtaining client sign-off as to resolution of all hospital questions regarding the review findings and recommendations, St. Clair issues the final report.

Benefits

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.

Pricing Approach

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.