An Overview Of PRC’s

Physician Based Coding, Compliance, & Documentation Reviews

In addition to validating code assignments, PRC will identify services that were not coded/billed, and make recommendations on Clinical Documentation opportunities. We provide our recommendations in a comprehensive report with each case re-abstracted with suggested code assignments, supporting references, and potential financial impacts. Our comprehensive final reports also provide useful statistics such as accuracy rates, which can be customized to be Physician specific, Coder specific, and/or as a group, to best fit the needs and objectives of our Client.

Some Key Elements

PRC’s Physician based reviews can be customized to fit Client’s needs based on the number of Providers and/or Specialties. These Reviews can also be tailored to include ongoing reviews, support, and education where warranted. Some of the major elements included in our Reviews are:

  • Review Evaluation and Management (E&M) Codes for proper Utilization of the 1995 or 1997 E&M Guidelines

  • Evaluate ICD-10-CM Diagnosis Codes to the Highest Level of Specificity

  • Review Procedural CPT Codes

  • Verify Modifiers Assignment

  • Verify Global Periods

  • Review #1500 Billing Forms for Accuracy and Proper Mapping of Codes

  • Evaluate the Level of Physician Documentation

  • Identify services/procedures not Coded or Billed

  • Review for Accurate and Optimal Reimbursement

  • Evaluate the Overall Level of Compliance

  • Comprehensive Educational Sessions to Coders and Providers

  • Provide Accuracy Rates and Financial Impacts by Provider and Coder