Audit Support and Compliance Services

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THE NEED: Healthcare practitioners face numerous challenges today, underscoring the critical importance of thorough documentation to meet coding, reporting and billing requirements for Evaluation and Management (E&M) visits, minor surgical procedures, certain supplies, and other medical and behavioral health services (e.g., preventive services, immunizations, psychotherapy, etc.). Since 2021, numerous changes have occurred that require healthcare organizations and facilities to identify deficiencies and implement strategies to optimize applicable documentation, coding and billing practices. Conducting documentation and coding reviews provides a unique opportunity to identify potentially non-compliant practices and loss of potential revenue.

HOW WE HELP: ArchProCoding conducts thousands of documentation and coding reviews annually, focusing on E&M services and other coding and billing aspects for Rural Health Clinics (RHCs), Community Health Centers (FQHCs), Critical Access Hospitals (CAHs), and small rural hospitals. We offer tailored audit strategies to meet each client's specific needs. We have streamlined a process for sharing protected health information (PHI), conducting documentation and coding reviews and communicating findings to our clients in a manner intended to identify deficiencies and educate providers and staff to address findings and implement corrective action measures.

WHAT WE DO: In light of the significant updates to CPT and CMS guidelines, effective documentation and reporting of services are more crucial than ever. We empower clinical providers by using their own progress notes to educate them on coding and billing responsibilities. This approach enhances their understanding of complex rules compared to traditional training methods alone. Our comprehensive approach includes audits, provider-specific executive summaries and high-level education for each provider reviewed.

Audit Process Overview:

  • Each provider undergoes a baseline Evaluation and Management (E&M) service audit consisting of 10-20 encounter selections covering diverse service types (e.g., new patients, established patients, preventive medicine services, etc).
  • Hospital audits include 10-20 records based on service types such as inpatient/swing bed facility, observation, emergency department, etc.
  • Audits focus on:
    • Medical necessity or time as criteria for E&M levels.
    • Accuracy of CPT/HCPCS-II modifiers where applicable.
    • Specificity and assignment of ICD-10-CM codes.
  • After the audit, clients receive an executive summary and audit template showing coding accuracy rates and findings for each provider.
  • Provider and/or staff education sessions may be scheduled following the documentation and coding reviews to address concerns of lost revenue or noncompliance. On average, these educational sessions typically last 30-45 minutes.

WHAT WE NEED FROM YOU:

  • Execution of a HIPAA-compliant Business Associate Agreement (BAA) before PHI dissemination to comply with HIPAA and HITECH.
  • Use of our HIPAA-compliant Citrix ShareFile for PHI transfer, with access granted upon service agreement execution.
  • Completion of a pre-populated Excel spreadsheet with patient demographic info and reported CPT/HCPCS-II/ICD-10-CM codes.
  • Our experienced audit team reviews the data and schedules provider training or Q&A sessions based on the audit findings. Training can be offered virtually or in-person. If the education requires an on-site visit, all travel expenses will be invoiced separately.