Chart Audit
How does your medical practice meet national coding compliance standards? ProMed performs a comprehensive analysis of your practice’s current coding, and goes the extra mile to equip your staff with the education and skills to manage compliance and reimbursement issues.
“We believe that the development and issuance of this voluntary compliance program guidance for individual and small group physician practices ….”
Pg 59434 /Federal Register / Vol. 65, No. 194 / Thursday, October 5, 2000 / Notices
What a misleading statement! Medical Coding Compliance is not voluntary! Physicians are being penalized, paying back improperly collected monies, and losing their status due to not making sure they are a compliant practice. In worst case scenarios, some are going to jail for medical coding fraud and abuse.
Individual and Small Group Practices are CMS carrier compliance TARGETS!
I have spoken to contractors who perform CMS investigations. Some carriers have programs specifically to target small practices, and are assessing “risk” in rural areas in special investigations.
Do you know what to look for? What are your risks?
A major part of any physician practice’s compliance program is the identification of risk areas associated with coding and billing. The following risk areas associated with billing have been among the most frequent subjects of investigations and audits by the OIG:
- Billing for items or services not rendered or not provided as claimed;
- Submitting claims for equipment, medical supplies and services that are not reasonable and necessary;
- Double billing resulting in duplicate payment;
- Billing for non-covered services as if covered
- Knowing misuse of provider identification numbers, which results in improper billing;
- Unbundling (billing for each component of the service instead of billing or using an all-inclusive code);
- Failure to properly use coding modifiers;
- Clustering; and
- Upcoding the level of service provided
Who are our clients?
- Attorneys
- Hospitals
- Individual and Multi-Specialty Group Physician Practices
- Laboratories
- Outpatient and Freestanding Clinics
- Specialty Groups
Contact us today to learn more about our services and how we can help you.