Are you receiving denials based on coding errors? Are you sure there are no gaps in the billing process? Are ICD-10 codes being used appropriately and reflect the patients’ conditions in all their entirety? If you couldn’t answer “yes” to all those questions it might be time for an Audit. MMHCS provides both Billing and Coding Audits based on your practice’s needs.

During our Billing Audits we review the entire life cycle of the claim in the billing system based on the appropriate rules and regulations. The analysis will determine all levels of audit eligibility, charges captured, provider, location, submission, and adjudication of the claim. All types of visits will be captured including billable, non-billable, and additional enabling services that are being tracked in the billing system.

Review of encounters in EPM in a way the first major step towards ensuring an efficient billing process. In order to make sure that the encounter data is correct, we audit the following:

Comparison of charges in EPM and EHR

  • Verify that eligibility was verified and the encounter is billed to correct insurance.
  • Adherence to guidelines for each insurance – We verify that billing guidelines for each insurance has been complied with.
  • Correctness of other relevant data – We verify that all data related to encounter is entered correctly. For instance, multiple locations are not selected for the same encounter, multiple doctors are not selected for same encounters, DX is used for all procedures, and the provider misses no billable procedure.

The Billing Audit can be geared to focus on a specific time range as well as other criteria such as Insurance based on the needs of the clinic.

We also offer Billing Analysis options for Aging, Payment Posting and Denials, and more. Please contact us for more information.

The Coding audit can also vary by subject and scope of work. typically one if not all of the following three areas are included in the Coding Audit Scope:

  • ICD-10 Diagnostic Coding Audit – This is where we evaluate the diagnostic codes being submitted for completeness, accuracy, and specificity. To do this we compare the data provided in the notes and other documentation to the Provider’s assessment.
  • Evaluation and Management Coding Audit – In this audit we would look at the submitted E&M, or Office Visit, CPT code and compare it with the supporting documentation for accuracy.
  • CPT and HCPCS Audit – This audit is used to identify current non-office visit procedural and supply coding practices. To do this we compare the data provided in the notes and other documentation to the submitted CPT/HCPCS. This includes the ICD-10 codes linked to the procedure code(s).

The results from the aforementioned audit(s) will be compiled into a single deliverable. The Final Report will provide an overview of common issues found, examples of those issues, improvement goals, and suggested action plan(s)

Once the audit is complete we offer additional services to help your clinic with the identified gaps and areas for improvement. These services can include items such as Implementation and Project Management to Provider and Staff Training. Please see our other services for more information or Contact Us.