Physician Practice Coding/Billing Review

Process

For each medical case, a St. Clair Senior Consultant checks the accuracy of the coding for patient office visits and associated ancillary services (e.g., injections, laboratory, and radiology), submitted on the CMS 1500 billing form, against the clinical record documentation and the applicable coding guidelines. For the surgery performed on each surgical case, the consultant assesses the accuracy of the coding, submitted on the CMS 1500 billing form, against the clinical record documentation and the applicable coding guidelines. The scope of the surgical case review can be expanded to check the coding accuracy of the office visits and associated ancillary services during the applicable global billing period. Also, for each patient office visit, St. Clair assesses the accuracy of the Evaluation & Management (E&M) service level assigned.  For all of our recommended coding changes, St. Clair will provide the rationale citing applicable coding guidelines and/or clinical record documentation.

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

Benefits

The St. Clair coding and billing compliance review will assist the Practice to improve documentation for and reporting of its billable office visits & associated ancillary services and, if applicable, its surgical procedures. This should help to minimize the possibility of the Practice’s receiving claim overpayment notices due to RAC audits.

Pricing Approach

The St. Clair professional fee for a Practice coding and billing compliance review is competitively priced per reviewed case.