Compliance
Compliance has become a necessity in every practice.
EMstrategies’ extensive auditing experience can provide the following services to assist your practice with compliance to the documentation and coding guidelines:
- Development of Regulatory Compliance Programs;
- Assessment of Potential Liability;
- Monitoring of Coding Programs;
- Interactions with Payers; and
- Coding Audit Services.
Coding Audit Services
For an audit,
EMstrategies reviews a random sample (usually 150 - 250 charts) of previously coded emergency department records, the previously selected CPT-4 and ICD-9-CM codes for each record, and the designated payer class for each record. This information is reported in a comparative analysis of
EMstrategies’ code assignment to the client’s code assignment. This comparison facilitates development of coder accuracy level and assessment of client liability through error recognition.
EMstrategies’ suggests clients include chart samples with the same percentage of admitted patients relative to the overall emergency department admission rate (e.g., patients seen and treated in the emergency department and subsequently admitted). This subset generally represents the highest liability for payer audit and recovery. Upon completion of the chart review,
EMstrategies provides a written report of findings and observations. This report includes the following:
- CPT procedure code and modifier utilization per EMstrategies’ review compared to CPT code utilization assigned by the client’s coding staff;
- ICD-9-CM diagnosis code utilization per EMstrategies’ review vs. ICD-9-CM code utilization assigned by the client’s staff (to determine whether correct ICD-9-CM codes were assigned). EMstrategies’ also looks for coding of the patient’s chief complaint or symptoms necessitating the emergency department visit. These codes are often the basis for payment for many carriers; and
- A brief summary of the findings of the audit. The summary will include a sample of charts (10 – 15% of the total) demonstrating the most common errors found during the audit.
