Healthcare Management Solutions

Medical Coding Audits

Gianni Gonzalez Ph: (904) 465-2863 medicalcodingaudits.com Medical Coding RAC Audits Chart Auditing Denials Management

Medical Coding Audits

HealthCare Management Solutions specializes in practice management with over 20 years experience in physician practice operations, reimbursement, and education. Our certified coders have extensive experience with government audits. Once we have received all of your information and the audit is performed, we will deliver a report to you in approximately one week later. The results of that report will be reviewed with you. We will help identify and make suggestions in areas for improvement. Our report will allow you time to make any changes in your current practices.

Denials Management

According to a recent study by the Health Insurance Association of America, 14% of all claims submitted to payers are denied - that is one in seven that need rework, resubmission, and possible appeal by the provider. The same study found that six percent of EDI claims are rejected even before entering the payer's claim system, and these are not even counted as denials.

Typically only half of all first denials are ever appealed even though 45% of all first denial appeals are won. The study also showed that 50% of second denial appeals are won and 10% of third denial appeals are won.

Medical Chart Audits

Auditing medical charts is the first step and a most critical part of any successful medical office operation. Although chart auditing may seem intimidating for many physicians, there are many positive aspects of chart auditing including increased revenue, treatment efficacy research, and peace of mind in the event of third party audits. New attention from the OIG, RACs, and other third-party auditors makes this built-in practice self-check more important than ever.

HealthCare Management Solutions offers concurrent and retrospective audits for a charge based payer population. These audits can be performed remotely. Their professional coders are members of the American Academy of Professional Coders and can prepare an on-site audit of approximately 10-15 patient charts to ensure compliance with Medicare (CMS) guidelines and to establish proper billing and documentation procedures to protect you and your practice from a Medicare audit. It is important to make sure all of your records are in order in the event of such an audit.

Medical Coding Audits

• Reduce the quantity of denied claims
• Receive fewer claim errors
• Identify and eliminate common mistakes
• Examine the top reasons for denial
• Develop a process improvement plan
• Implement methods to prevent common denials

RAC Audits

RAC stands for “Recovery Audit Contractors.” These contractors are hired by the Centers for Medicare & Medicaid Services (CMS). Their purpose is to audit and recover dollars to put back into the Medicare Trust Fund. These contractors have a huge incentive as they are paid on contingency (based on what they recover) on a percentage basis, so you can be sure they will be aggressive in their audits. Any overpayments found by the RACs will need to be reimbursed to Medicare, which can collected from reimbursement on future claims checks owed to you.