As the Health Care Reform Act and the transition to ICD-10 create additional compliance demands, the regulatory environment continues to demand greater amounts of time and attention. Documentation and coding reviews are a necessary part of compliance, and medical practices must ensure that codes are accurate to capture legitimate payment for work performed.

PBSI provides a full range of audit services that can reduce denials, file appropriate appeals, increase efficiency, and accelerate the revenue cycle. Our Medical Audit Review services demonstrate to clients where improvements are needed to achieve or improve accuracy and compliance. Our assessment summary translates the audit findings into an action plan for improving performance, and our professionals can provide training to improve coding and clinical knowledge.

Our Medical Audit and Review Unit is composed of Registered Nurses who apply ICD-9 and ICD-10 coding guidelines, crosswalks, auditing procedures, and diagnosis related groups (DRGs) to review claims for errors. Our professionals have years of experience and clinical knowledge, as well as an in-depth understanding of national and local coverage decisions. We routinely monitor regulations and legislation that affect the industry and apply that knowledge for our clients. We can work with billing or compliance staff to ensure that claims are coded correctly, medical records document the care provided, and denials are addressed through appeals or resubmission of claims as indicated. Lastly, our team will create a strategy of suggested interventions, based on the work environment, to indicate areas for procedural improvements.

Types of medical audit review services we provide include:

• Focused Audit Services
• EMR Coding / Documentation Review
• Tailored Audit Services

Contact us for more information on how we can customize our Medical Audit Review services to support your specific needs.