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The OIG (Office of Inspector General) recommends that healthcare providers perform regular periodic claims audits to verify that services are being billed correctly to Medicare and other third-party payors. An effective auditing program can decrease your compliance risk and increase your peace of mind.MDmanagement will perform audits tailored to your specifications: on-site or off-site, prospective or retrospective, and as large or small as you wish. Our consultants will pinpoint areas of compliance vulnerability, as well as untapped revenue, and maximize proper reimbursement.

The Coding Audit Service is provided by Coding/Reimbursement specialists who are Certified Professional Coders. These specially trained individuals:

  • Review all of the activities involved in the reimbursement system and process (charging, pricing, claim filing, claim tracking, EOB documentation, etc.);
  • Spend time with each key staff person, providing immediate, hands-on training;
  • Provide individual consultation to physicians; and
  • Gather data, materials and information from your office to support our analysis and recommendations.

Operational Assessment Are your billing costs rising, but your reimbursement is lagging? MDmanagement operational assessment may be just what the doctor ordered. Our experienced coding professionals will examine your front-end and back-end charge entry and billing processes to identify the “black holes” that are draining your revenue, including:

  • Missed charges / misuse of modifiers
  • Inefficient workflow
  • Duplication of effort
  • Errors

The objective of a coding audit is to enable a practice to…

  1. Code, charge, and file claims in such a way for optimal reimbursement;
  2. Ensure that all services provided are rendered; and
  3. Ensure that the practice is compliant with policies and regulations.

A coding audit allows an MDmanagement consultant to ensure that the entire coding-billing-reimbursement-documentation process reveals that:

  • Services are coded correctly
  • The practice is compliant with Medicare and private payers
  • The practice bills for all of the (billable) services
  • Provider documentation supports the codes used

A coding audit includes a written report and a follow-up audit with instructions for correcting any detected problems. An MDmanagement consultant will present the report, and all areas of review will be discussed in detail. Hands-on training for both physicians and staff is an option.

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