Consulting - Coding and Documentation Audits
"We aren't certain that our documentation supports the codes we bill."
"We don't know if we're billing for all services, and capturing all legitimate income."
"We think we are losing money for services that were documented, but never billed."
Inappropriate coding can reduce your income and/or increase your risk of an audit. KZA works with practices to assess and address their coding and documentation strengths and weaknesses. The following modules provide you with examples of how we design and price these services.
Each project is customized by sample size and the goals of the individual practice. For example, your practice might be preparing to implement a compliance plan, address coding and reimbursement challenges, or improve physician understanding of documentation requirements through on-site training. We'll work with you to arrive at an appropriate sample size for the project, as well as determine whether to deliver a prospective or retrospective review of the documentation.
You can select from one, or both, of the following services:
Evaluation and Management Note Review
An evaluation of how well evaluation and management coding matches its supporting documentation. Using data you provide, KZA assesses the practice's coding and documentation strengths and weaknesses.
This project is usually performed off-site. Typically, the practice sends a sample size of six evaluation and management notes per physician. You provide us with a CPT frequency report for each physician. We then identify the specific visit type and level we want you to select for review. KZA evaluates each note and provides an annotated chart note attached to a copy of our completed review tool, along with a one page, written snapshot of each physician's results.
Some clients like to schedule a telephone consultation/debrief following the review.
Surgical Case Coding Review
Are there particular cases where you are concerned about the coding and/or reimbursement? Are there any outlier coding patterns for a particular physician, based on the practice's reimbursement patterns? Then in addition to the Evaluation and Management Note Review, you may want us to review surgical cases too.
This service provides an evaluation of how appropriately surgical cases are coded, and how accurately the practice has been reimbursed by third party payors. Using data you provide, KZA assesses the practice's coding and documentation strengths and weaknesses.
The project is usually performed off-site. We'll use a CPT frequency report to identify the types of cases that have the most financial and/or risk management impact or, some practices already know the cases that are challenging them from a coding and/or a reimbursement standpoint and make their own selection.
The investment varies depending on the number of physicians and number of notes or cases selected for review. We provide a fee quote based on the unique needs of each individual practice.
If you are interested in a coding and documentation review, please contact KZA's Client Services Director, Colleen Gallagher at (312) 642-5616.