Compliance and Documentation Audits
Services Offered
Billing and Coding Reviews
Physician/Attorney Support
A Compliance and Documentation Review is provided to determine if physicians and other practitioners are coding evaluation, management and other services correctly. A representative sample of the documentation is audited and recommendations are made to assist with coding more appropriately. Training can be provided to assist practitioners with this complex process. Documenting correctly is critical to accurate payment and compliance with all insurance payers. This can avoid refunds or penalties by the payer and investigation by the Texas Medical Board.
Billing and Coding Review is done to determine if the billing and front office staff is efficient in maximizing the collection of revenues. It will also determine if the practice is following Medicare, Medicaid, and other payer’s guidelines for appropriate, medically necessary billing and coding. Efficiency in coding and billing allows for higher revenue generation.
Audits are at an all time high from payers. When physicians need assistance with audits or other reviews by Managed Care plans, it is critical to have representation to ensure their review was done appropriately.
Managed Care Contract Negotiation
Contract Review and Negotiation Services is designed to maximize revenue for the practice by identifying insurance carriers with unfavorable fees and determining opportunities for negotiation. Better fees allow the practice to maintain overhead and generate more revenue.
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