Provider Record Reviews
As recommended by the OIG, PCA will conduct Provider Record Reviews to determine if providers are correctly coding and billing for services provided to patients.
PCA will review provider notes to see if the provider is coding and documenting correctly, incorrectly, over-coding, under-coding, coding correctly, but the note has insufficient documentation to support the code, and any missed billables. PCA has audited over 100,000 records and increased practice revenues between 5-31%. We have helped practices to understand the significant risks associated with over-coding. We have eliminated or lowered paybacks to insurance companies, as well as successfully overturned many government audits.
- Review 10-20 records per provider
- Determine a provider's "individual" level of understanding on how to appropriately code and document
- E&M services for optimal legitimate revenue return, per established CMS and AMA guidelines
- Identify any coding patterns which pose a risk to audit
- Identify any coding patterns or individuals which triggers claim rejections / posing a financial loss on the center
- Provide a formal report with individual and group graphs to support conclusions and recommendations for changes
- Optional educational training sessions available
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