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A practice management consulting and training firm working for and with physicians since 1985

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.

Your Investment

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.

Why Have KZA Review Your Coding and Documentation?

Because our well-recognized consultants are experts. For more than 25 years, KZA has taught physicians, managers, and staff how to code within the guidelines of CPT and Medicare.

KZA consultants have unique experience with specialty-specific coding and documentation, and are the national coding instructors for:

  • American Academy of Orthopaedic Surgeons
  • American College of Surgeons
  • American Society of Plastic Surgeons
  • Society for Vascular Surgery
  • American Association of Neurological Surgeons

In the past, KZA also participated in programs sponsored by the American Academy of Otolaryngology-Head and Neck Surgery, American Association of Neurological Surgeons, North American Spine Society, American Association of Hip & Knee Surgeons, Pediatric Orthopaedic Surgeons, American Neurotology Society, American Academy of Facial Plastic and Reconstructive Surgery, The Society of Laparoendoscopic Surgeons, Scolosis Research Society, American College of Osteopathic Surgeons, American Academy of Professional Coders and American Society for Surgery of the Hand.

Learn more about our coding experts...

...and sample their coding knowledge by checking out our Coding Coaches pages.

KarenZupko & Associates, Inc. • 625 North Michigan Avenue, Suite 2225 • Chicago, Illinois 60611 • 312.642.5616 • FAX: 312.642.5571

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