Audit & Compliance
Compliance audits can verify any of the following measures:
Accuracy of documentation to Evaluation and Management (E/M) code selected.
Statement as to how many levels of variance from code billed.
Statement as to how many codes were under-coded versus over-coded.
Accuracy of documentation to support any modifiers billed.
Compliance to bundling standards determined by the CPT manual as well as the National Correct Coding Initiative (NCCI).
Compliance to the Surgical Package Standards.
Accuracy of documentation to support any procedures/surgeries billed.
Compliance to signature requirements.
Verify that the medical record created by an Electronic Medical Record (EMR) system does not appear cloned.
Verify documentation in the medical record can support the diagnosis codes billed, both in level of specificity and priority.
Verify that the complete documented medical record meets the standards determined by the Office of Inspector General (OIG) to be a “complete” record.
Verify that “incident-to” guidelines are being properly met and documented.