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.
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
Please contact us for an initial consultation. Whether you know exactly what your facility needs, or whether you want PRC to assist in developing a roadmap to success based on your specific objectives, we are looking forward to working with you.
Call today at (800) 848-8772 or Email us at email@example.com
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