Baseline Audit Service
Approach
We will conduct a detailed audit by reviewing a random sample of patient chart data, coding, claims filed and reimbursements received during the targeted time frame. While the sample is random as to specific patient visit selection it is targeted at certain higher-profile activities intended to mirror the targeted approach the actual RAC auditors will undertake. RAC auditors are not permitted to target just higher dollar claims for example and there are other guidelines they will follow. The baseline audit report will provide findings and recommendations.
Benefits
The baseline audit will provide an independently conducted, objective review of accuracy and appropriateness for the targeted time frame resulting in the following benefits:
- Confirmation of accuracy and effectiveness conducted and documented by a team of credentialed coding and billing experts
- Identification of any areas that require improvement or remediation in advance of the RAC audit to allow for implementation of required change and preparation for official findings
- Identification of areas that may require additional internal review or focus prior to the RAC audit and on an ongoing basis identify opportunities to improve clinical documentation
- Identification of any under coding and resulting under billing that may provide revenue enhancement opportunity without increased risk
Methodology
Office Management Partners can partner with you and your staff to free them up for more pressing patient needs within the office while we ensure that this important but time-consuming task is performed reliably and at a reduced cost.
The baseline audit consists of a detailed review of a sample of 50 patient charts from the review period. Our process involves determination of the sample population based upon a methodology designed to mirror that of the RAC auditors as closely as possible increasing the value of the results. By hiring us for this service you are retaining a 3rd party contractor audit report as part of your readiness plan which in itself shows your awareness of the need to self-police the Medicare reimbursement process which is at the target of the program.
The general make-up of the sample will follow a pattern similar to the following example;
- Random 20% of charts for 99212
- Random 30% of charts for 99213
- Random 30% of charts for 99214
- Random 20% of charts for 99215
Upon signing up for a baseline audit we will provide information to you and your designated staff who will be participating in pulling the data required for the audit. A date will be determined for the data collection which can be scheduled right away and held usually within one week of signing for the service. The data collection is accomplished within one day and depending upon the number of specific audit samples (usually corresponds to number of separate physician identification numbers, PINs, for the practice) can run from 2 to 8 hours. After the data collection the audit is performed and within 10 business days we will contact you to schedule a meeting to present the audit results. Once we contact you this can be scheduled any time you are available. You can review the results while we are there and can call us any time afterward with any questions or to request clarification on anything if needed. Based on this schedule the time frame from initial signup to the date the report is presented is usually approximately 3-4 weeks.
The end product includes a report that we deliver and review with you that includes findings as well as recommendations for improvements to your clinical documentation processes. You can use this to improve your processes, identify areas for further review or training, assess positive or negative financial impacts of any miscoding and you can use it as part of your overall RAC plan to show the RAC auditor that you have taken pro-active steps to secure independent review in an attempt to address any areas of need in a proactive manner.
Schedule
The process can be completed in a relative short time frame depending upon your schedule and desired time frames.
Scheduling of Data Collection ... Done via phone call
Data Collection ... As scheduled (length within 1 day)
Audit Work ... Completed 10 business days after data collection
Audit Report Review ... As scheduled (1-2 hour meeting)
Resources
We will work with you to ensure the sample documentation is pulled and collected for the audit. The audit work will all be performed by our team in our home office minimizing impacts to your staff. There will be a need to utilize your office space for the chart data collection during the one-day data collection phase. There will also be a need to utilize your office fax machine during that time to send the data through to our HIPAA-compliant, 128-bit encrypted secure site housing the data. This is done via a toll-free number. No other resources are required from your practice.
Qualifications
The audit will be performed in our home office in Virginia by a dedicated team of certified coders. The team includes certified coders in all specialties so that experts specific to your types of patient activity are assigned to your audit. All are HIMA and AAPC certified. Our audit team, an extensive network of certified medical coders with years of experience, assures accurate and complete coding that is fully compliant with all of the Correct Coding Initiatives (CCI) and Local Medical Review Policies (LMRP).
Pricing
This audit service is priced on a project basis as opposed to hourly. The audit includes the 50-chart review per physician identification number. As mentioned the fax machine resources are supplied by you but there are no other expenses that require reimbursement and the secure-site fax uses a toll-free number.
Contact us today for a quote on supplying your practice with this valuable service.
Office Management Partners would like to help you meet the challenges of assessing your position going into the RAC Program roll-out for Pennsylvania. This is just an example of one service we offer within our company mission to partner with you and your office management staff to free you up for what you do best, care for your patients. Please call us with any questions and we look forward to working with you.