How vulnerable is your practice?

Reducing healthcare fraud and abuse has become a top priority for government and commercial payers. Investigations are on the rise and if you’re like most healthcare professionals, you fear becoming the next target of highly motivated auditors. As government and commercial payers develop increasingly sophisticated technologies and protocols to target physicians based on coding and documentation practices, compliance officers and other healthcare professionals are scrambling to stay off the radar.

When was your last coding and compliance review?

While inaccurate coding as well as provider inefficiencies can increase your overall exposure to the risk of non-compliance, it can also create a drain on your revenue. It is crucial to stop these drains sooner rather than later since the lost revenue often takes as much time and effort to recover as it took to earn it in the first place.

Reduce your risk and revenue leaks with a coding and compliance audit performed by experienced professionals. DoctorsManagement has several distinct advantages over other medical coding and billing firms.

  • Our team has access to ComplianceRiskAnalyzer, a proprietary risk-assessment technology that assesses critical risk areas using sophisticated analytics that are similar to those used by Medicare. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.
  • DM’s in-house auditors are US-based and certified as both Certified Professional Coders and (CPC) and Certified Professional Medical Auditors CPMA, and they receive ongoing support and training from the National Alliance of Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.
  • Since DoctorsManagement is a full-service consulting firm, the many departments within our firm work together on challenging issues to ensure that our clients receive the highest quality results.
What can you expect from your coding and compliance audit?

Our team conducts a review of your coding, billing and documentation procedures in a manner that closely simulates an actual carrier audit. We compare your existing practices to CMS and National Guidelines as well as the medical necessity of the encounters. We provide you with a report on your evaluation and Management (E/M) coding accuracy, documentation, accuracy of procedural coding, accuracy of modifier assignment, bundling as well as potential issues with your Electronic Medical Records (EHR) such as faulty templates. If requested, we can also review ICD-10 reporting from a Risk Adjustment Coding (Hierarchical Category Coding – HCC) perspective for those who participate in Risk Adjustment Cost Sharing to ensure all risk adjusted coding opportunities are being captured as well as educate on documentation which falls short of fully supporting diagnosis codes as reported. Our report includes recommendations to correct the issues as well as recommendations for training to help mitigate future risk.