Comprehensive compliance audit services
We aim to provide you with services that will free you to devote more time to caring for your patients. While you go do that we will ensure to reduce denials, follow regulatory compliance and increase revenue. All this would be done in compliance with payer and Government rules and regulations.
Our chart audits feature a detailed analysis of historical charts, related documentation and trends in reimbursements. Using coding methods, we identify patterns and tendencies. This is followed by a detailed report of the findings. We also provide recommendations and cross-references regarding the best practices in the industry and specialty.
The code compliance process
We provide foolproof solutions to audit medical claims leveraging a combination of validated audit practices, expert professionals and most definitive analytics technology.
Our experts work to improve your process efficiencies & rectify errors
At Practolytics, our subject matter experts ensure that we deliver a seamless user experience and process correctness all across the RCM modules.
We conduct audits of end-to-end revenue cycle processes including code assessment, billing information, charge capturing, data transfer protocols and related documentation to identify and fix errors and inefficiencies.
What we promise to do for your Revenue Cycle Management?
FAQs about Compliance Audits
What is a compliance audit in medical RCM?
It is the process of assessing historical & current claims and ensuring that claims are submitted in compliance with Local and National Coverage Determinations and payer-specific guidelines(LCD).
What are the different phases of the audit process?
There are four main phases of the entire compliance audit cycle. They are Preparation, Performance, Reporting & Follow-up.
Why do we use encrypted emails and password protected attachments?
Encryption of emails protects the contents of the email and the content of the attachments when it reaches unintended recipients. We mandate emails to be encrypted and passwords to be protected in our organization as increased security and compliance measures.
Why is it necessary to record the payer denial code/reason on the patient’s account in the billing system?
It is an appropriate audit trail. It ensures appropriate follow-up action is taken. It tracks and establishes trends of potential billing and/or coding problems. This report can be utilized for account analysis as well.
How can we get our doctors to follow documentation guidelines?
Education, feedback and more education. You must be persistent and follow through to show your commitment. We audit doctor’s medical records and any inconsistency is taken as an education source to educate physicians.
If someone other than the physician documents the history, ROS, medical, social, family history, can I use it when determining the level of E&M cpt?
You can use the ROS, past medical, social & family history. The provider’s documentation should support that they reviewed the ROS and PFSH documented by the ancillary staff. The history of present illness needs to be taken and documented by the physician.
How often do employees need compliance training?
Employees working in various healthcare roles, including coding and billing, should be trained in appropriate areas (HIPAA, HITECH, etc.) immediately upon hire and at least annually thereafter. Employees should be trained when existing regulations change or are updated and when new regulations are put into place. Our experienced training team ensures this is being followed to all our employees on board.
What resources are used as compliance reference resource?
Resources that included for references are: OIG, the Centers for Medicare & Medicaid Services, the U.S. Department of Health & Human Services, and AAPC. These organizations provide informational articles, auditing software, news about updates and alerts, compliance ideas, and more.
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