MEDICAL BILLING AND COMPLIANCE AUDITS
We work with investors and their healthcare platforms to identify any potential medical billing risk and partner with our clients to create audit, training, and ongoing education programs to mitigate the risk of third-party payor audits.
Pre- and post- acquisition audits:
Pre- and post- acquisition medical billing audits are conducted on a selected sample of charts for a specific timeframe for each practitioner in the platform. Medical record documentation and claims are reviewed to validate the service codes billed.
Our clients are provided with a final report detailing audit findings based on federal and commercial payer guidelines. In addition, we relate our findings to the potential impact on practice revenue, as well as benchmarking against CMS data.
Once a pre-acquisition audit has been conducted, we recommend follow-up audits on a regularly scheduled basis until the platform or practice achieves satisfactory audit scores based on OIG standards. Until a satisfactory audit score is achieved, we may recommend that the practice participate in a pre-payment audit or focused audit. This allows us to audit charts before the claims are submitted to the payer which reduces the risk of payer scrutiny and audits.
Post-Audit Assistance – Annual Audits, Focused Audits, and Education and Training:
Post-acquisition, we conduct annual and focused audits for our client platforms. We recommend our clients continue to monitor performance and compliance with billing guidelines.
We educate staff on correct billing, coding, and documentation practice. Risk areas identified as part of the audit become the primary focus of this training. This training will take place as soon as possible after the baseline audit to mitigate continued risk to the practice. We work with the platform to implement either an on-site or web-based training program.
As regulations and coding requirements change, we continue to educate clients on coding changes, Medicare bulletins, fraud alerts, quarterly correct coding initiative changes, annual coding changes, specialty specific changes, and Evaluation and Management documentation guideline annual updates. This training can be achieved in small or larger groups, as well as one-on-one. Programs are customized based on our client’s needs and resources.
For information contact: Joyce Ehrlich, CEO
Email: joyce@keapstreetadvisors.com
Phone: 917-432-4460