Medical Records Audit      
Reimbursement Review     
Compliance Verification     
Doctor Correct Coding Education     
Staff Coding and Reimbursement Training    

 

Appealing a Negative Audit           

 

   
             Medicare, Blue Cross, VSP and other payers are performing more audits than ever before
          
Payers have significantly increased the number of auditors.  Auditors are much more aggressive
           Some payers pay their auditors a bounty on how much they take from you.
          
According to the payers, Over 90% of practices fail an insurance audit!
          
Penalties for negative findings are between $150,000 to $200,000!
          
Many doctors believe using an EHR system keeps them compliant


           Frequently this is not true.  Many EHR systems produce non-compliant records

             We know what the auditors are looking for.  We can protect your practice!

            These audits are being conducted for a number of reasons including exam documentation and creation of Interpretation and
                 Reports.  We ensure your exam documentation will meet or exceed NCCI standards.  We verify you are creating
compliant
                 Interpretation and Reports.

            Many Medical Records systems falsely verify exams as complete.  Missing key exam requirements. 
                 Auditors specifically look for these and we know what the auditors are looking for. 
                 We will detail your exam deficiencies before the auditors do.

            Practices hit with a negative audit are frequently surprised and frustrated.  They previously passed an audit and have the
                 same records.  However, in many cases these practices only had a "Request for Records."  This is not a full audit. 

            Even if you had a previous audit, all payers are now much more aggressive in audits than even a couple of years ago. 
                The auditors are looking to find problems! 

            In almost every audit we have performed, the practice would have failed an insurance audit for high penalties. 
                We were able to identify specifically where their records were not compliant, make detailed recommendations enabling
                the practice to be fully compliant!  We can do the same for you!   Let us help you before you are audited!

            Most practices pull forward information from previous exams without making changes.
               This is "Cloning" by CMS and other payers.  This will result in denials.
               Few practices know what steps must be taken in order to pull forward compliantly.

            Another advantage of our audits is that we look at lost reimbursement. 
                Procedures you should be performing for increased reimbrsement.
                Lost reimbursement from incorrect coding, cliams submission and correct EOB processing. 
                In most cases the lost reimbursement we find is more than the cost of the audit.

We know what the Auditors are Looking for?

Protect Your Pocketbook!