A
DETAILED DESCRIPTION OF AN OUTPATIENT
MEDICAL RECORDS REVIEW
Our
Outpatient Medical Records Review focuses
on compliance with all Government regulations,
and includes accuracy and reimbursement
issues as well. This Review encompasses
Ambulatory Surgery cases, Diagnostics
not hard coded into the Charge Master,
Observation cases, Emergency Room visits
with their UB-04s and Detail Bills
to insure accuracy when billing claims.
This Review process includes ICD-9-CM
diagnosis codes, CPT procedure codes,
Evaluation and Management (E&M)
codes, an evaluation of the level of
documentation, NCCI edits, the utilization
of Modifiers, and APCs when apropos.
While on-site, an educational session(s)
can be provided for your staff and/or
physicians, and CE credits may be awarded
for attendance by their professional
organizations. A resolution session
will be conducted at the end of the
on-site visit, where all errors and
discrepancies will be discussed, and
our initial recommendations will be
presented. A comprehensive, written
report will be submitted subsequent
to the on-site visit.
Related,
Specialized Reviews and Audits
Comprehensive,
Compliance Review
CPT Code
Validation
E&M Code
Validation
Observation
Emergency
Room
MAJOR
OBJECTIVES OF AN OUTPATIENT MEDICAL RECORDS
REVIEW
Verify the Accuracy of the ICD-9-CM
Diagnosis Codes
Verify the Accuracy of the CPT
Codes
Verify
the Accuracy of the E&M
Codes
Verify the Accuracy of the Modifiers
Verify the Accuracy of the Documentation
Verify the Accuracy of Billing
Verify Compliance
KEY
ELEMENTS OF AN OUTPATIENT MEDICAL RECORDS
REVIEW
