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Codebusters medical records auditing services encompass four critical areas:
Clients we help include acute care hospitals, specialty hospitals, ASCs, HMOs, physician clinics, CAHs, RHCs, LTC, home health, and payers. Why Do a Claim Review? In this era of increased scrutiny, provider organizations must insure that their coded data contains few, if any material errors. The entire health system depends on accurate medical record data for pricing, research, quality of care measurement, and public health planning. Now that Medicare’s RAC auditors can recoup payments based on undiscovered coding errors going back several years, providers must be quick to identify errors to halt further financial risk. Without performing annual external audits (recommended by the OIG) and having a monitoring system in place, organizations may be unknowingly putting themselves at tremendous risk of both under-billing and over-billing. Given the razor thin margins of payer reimbursement, consistent under-billing could eventually lead to insolvency. On the other hand, with the ever increasing scrutiny from payers, any benefits of over-billing could be completely washed away with added penalties. Therefore, it is incumbent on providers to diligently analyze their claims for errors. Codebusters can provide an audit that meets your budget while clearly identifying the risk.
Codebusters auditors possess the skills and experience necessary to help our clients properly design and execute highly technical coding reviews. We work closely with HIM and revenue cycle managers to plan the audit scope and the service areas to be examined. Through our initial site interviews we come to a clear understanding of the coding and billing processes, current monitoring activities, and past audit results. This information informs the both the objectives of the audit and the method with which to achieve them. Reviews can extend to an analysis of documentation, coding, claims and statements, and reimbursement; or they can be focused on specific aspects of coding compliance for various payers. Because of the unique nature of each health care facility, we take a measured approach to establishing the size and scope of the audit. |
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