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Overview
Our primary objective in the performance of a billing and coding review is to obtain an in-depth and accurate understanding of an organization’s current policies, procedures and standard practices with respect to these critical functions, and thereby identify any activities that may represent potential exposures to the organization, as well as opportunities for operational improvement.
While our reviews typically encompass all aspects of a health care provider’s billing and coding processes, particularly those assignments, designations and submissions impacting governmental payment determinations, we also focus on specific areas that are, or have been, the subject of governmental reviews and investigations.
- DRG Determinations
- Diagnosis Coding
- APC Assignment
- Procedural Coding
- UB-92/1500 Accuracy
- Medical Necessity
- E & M Coding
- Modifiers
So as not to create any unnecessary operational burdens on the part of our clients, we recommend that our reviews be restricted to very recent, if not current, billing and coding activities. Our goal is to assess the accuracy of current claim submissions, particularly in relation to the patient care services and supplies rendered and the documented medical necessity of such services and supplies.
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