Compliance & Coding Audit Services

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Compliance is essential in every practice. EMstrategies' extensive auditing experience offers comprehensive services to ensure adherence to documentation and coding guidelines:

• Development of Regulatory Compliance Programs
• Assessment of Potential Liability
• Monitoring of Coding Programs
• Interactions with Payers
• Coding Audit Services

Trust EMstrategies to keep your practice compliant and secure.

For an audit, EMstrategies reviews a random sample of 150-250 previously coded emergency department records, including the selected CPT-4 and ICD-9-CM codes and designated payer class for each record. This data is analyzed in a comparative report, contrasting EMstrategies' code assignments with the client's, facilitating the development of coder accuracy levels and the assessment of client liability through error identification.

EMstrategies recommends including chart samples that reflect the same percentage of admitted patients relative to the overall emergency department admission rate, as this subset typically represents the highest liability for payer audit and recovery. Upon completing the chart review, EMstrategies provides a comprehensive written report of findings and observations, including:

• Comparison of CPT procedure codes and modifier utilization between EMstrategies' review and the client's coding staff
• Analysis of ICD-9-CM diagnosis codes to ensure correct assignment, with attention to coding for the patient's chief complaint or symptoms, which are often the basis for payment
• A brief summary of audit findings, highlighting the most common errors with a sample of charts (10-15% of the total)

EMstrategies' detailed and thorough approach ensures accuracy and compliance, enhancing the credibility and efficiency of your practice.