Medical Auditing
According to the U.S. Department of Health & Human Services, 42 percent
of claims are coded incorrectly.
Medical Chart Auditing
In the healthcare industry, medical chart auditing implies being on the same track with the documentation/compliance requirements and relevant federal/state regulations. Audits are an invaluable tool to your organization since they may directly influence your reimbursement flow. Internal medical record auditing services can be used to assess various aspects of your organization’s internal clinical reporting approaches.
If you want to ensure that your organization is following the stringent regulations laid out by the government and healthcare payers, then you need to take advantage of WCH’s medical record auditing services. This comprehensive service involves a rigorous review of the charts you make
Importance of Regular Medical Record Auditing
WCH recommends that you schedule medical record auditing services at least once per year. Internal auditing is essential if you want to protect your organization from undue liability, prevent extensive inquiries into your billing practices, and avoid potential penalties.
Regular audits also offer several other substantial benefits, which we’ll explore in depth below. Reading more
-
Experience: Professional and successful work since 2001; -
Safety: Certified professional auditors. Work with lawyers. Go to courts. -
Professionalism: National industry recognition and certifications from AAPC, AMBA, AHIMA, HBMA, HCCA, PAHCOM, BBB and OIG, OMIG compliant; -
Education: Extensive education for your staff; -
Valuables:- Readiness for insurance companies’ audit;
- Increase revenue. Eliminate unpredictable penalties.
-
Result Full report with proof, valid for insurance audits; -
Approach:Review,- Posted, partially paid and denied claims
- Claims affected by multi-procedure reduction
- Frequency of resubmitted claims
- Patient billings and copayment collections to ensure compliance with payers, state and federal laws
Identify,- Unclean claim percentages
- Loss due to excessive claim resubmissions
- Legal implications of undercoding and overcoding
- Lost revenue uncovered due to coding, recordkeeping and submission errors
- Front office training to ensure proper authorization and eligibility checking.
Analyze Recommendations to improve systems and practices -
Fees: Professional Fees: $ 120.00 per hour. A detailed invoice will be provided at the time the review is complete.
Tel.: (425) 463-9131
Our areas
of expertise includes:
Audiology
Cardiology
Chiropractic
Dermatology
IDTF
Internal Medicine
Mental health
Neurology
Physical Therapy,Occupational Therapy
Podiatry
Radiology
Surgery
Medical necessity
Denied claims
Bundling issues
Charge captures
Accuracy of medical
coding for diagnoses,
procedures
Patterns
-
Why do I need an Audit?With today's ever-changing regulations and high frequency of audits from governmental and other healthcare payers, the internal Audit is the vital process that every practice must undergo. It is recommended that medical practices conduct internal Audits at least annually to confirm compliance with the coding guidelines and documentation requirements. Protect your practice. Accurate coding and compliance with documentation requirements and healthcare payers guidelines directly affect your practice's income. -
What is included into the WCH Auditing Services?Auditing Services as per Client's request may include the following:
• Identification areas of risk leading to upcoding or downcoding in the documentation and medical coding accuracy;After the completion of the audit service, we provide a written report to the Client, setting out the findings, recommendations, and audit opinion arising from the Audit.
• Verification that coding practices are compliant with the regulations set forth by private and government payers;
• Education of providers and staff on how to use documentation to maintain HIPAA compliance;
• Complete Chart Audit;
• EMR Coding/Documentation Review;
• Review compliance with the Incident to guidelines and services performed on collaborative premises;
• Analysis of Denials/Duplicate billing /Appeal process (Pre-payment and Post-payment)/Modifier usage;
• Review of format and content of the health record as well as other forms of medical/clinical documentation;
• Coding, including ICD-10-CM, CPT, HCPCS;
• Analysis of billed claims, including the UB-04, the HCFA 1500, charging procedures;
• Review compliance with the State and federal regulations concerning the use, disclosure, and confidentiality of all patient records;
• Front Desk work review including but not limited to: Eligibility verification/Benefit maximums verification/Excluded services verification/Authorization process/Patient responsibility (deductibles, copays, coinsurance)/Coordination of benefits;
• Verification if any abusive billing or fraud exists;
• Insurance plans participation and consistency of contracted rates;
-
What is the fee for Auditing Services?The professional fee for Auditing Services is $ 120.00 per hour. The Auditing Services Agreement includes a retainer fee of $1,000. A detailed invoice is being provided at the time the review is completed.
Should I get a Second Opinion on My Billing for Profitability, Protection, and Peace of Mind?
Are you confident your staff or billing service is capturing 100% of your reimbursements? Probably not. In fact, practices lose up to 66% of their revenue annually due to coding and billing errors.
Now, there's an easy way to find out. Get a WCH Second Opinion.
WCH Second Opinion Internal Billing Audit Service is a quick and low-cost verification process that immediately identifies coding errors, recordkeeping issues and potential liabilities. Most importantly, WCH Second Opinion pays for itself by uncovering missed revenue opportunities.
Will A Second Opinion Help Increase Practice Revenue?
If your claims are being denied, you could be leaving many thousands of revenue dollars on the table every year. A WCH Second Opinion helps multi-location, multi-specialty practices and single office providers analyze billing practices, identify errors, and make changes to regain revenue.
Can I Audit Both Outside Billers and Internal Management?
Every medical practice should be auditing its billing practices annually. Coding errors, inadequate record keeping, incomplete submissions, and illegal shortcuts leave a practice vulnerable for an insurance audit. Make sure everyone involved with billing, both internal staff and outside vendors, is staying up-to-date, keeping comprehensive records and complying with the latest rules and regulations for each insurer.
How does this Benefit our Practice?
An expert second opinion will ensure you are maximizing revenue and minimizing common mistakes that could result in suspension of insurances or a medical license.
U.S. medical practices forfeit nearly $125 billion annually due to inadequate
billing practices.
Why WCH?
WCH reviews and processes tens of thousands of Medicare, Medicaid and private insurance claims every year. We know that billers without APPC and HBMA certifications frequently make mistakes due to lack of knowledge or carelessness that deprive providers of income because we see it every day.
Take advantage of our expertise and Get a WCH Second Opinion to ensure your in-house or other billing service is complying with changing rules and regulations and receiving maximum reimbursements. We will pinpoint deficiencies, recommend solutions, or confirm everything is on track.
for all types of practices, large and small, for more than 20 years. To find out more about our services:
