Millennium Healthcare Consulting, Inc

CODING AND DOCUMENTATION AUDITS

Millennium Healthcare Consulting, Inc’s ®, professional team of certified coding and compliance consultants perform independent coding reviews and education for physicians and staff, healthcare facilities, third party billing companies, CPA and law firms, and other healthcare organizations.

THE APPROACH:

Millennium Healthcare Consulting, Inc. ® conducts an initial phone interview with the client to determine their specific goals and objectives of the coding and documentation audit reviews.

MHC’s team of certified coding clinicians will then conduct an independent review of the documentation for the specific date(s) of services selected for review. When conducting evaluation and management (E&M) reviews, our audit review verifies that the CPT and ICD-9 code(s) accurately reflect the level of documentation and care provided to the patient for that given encounter. Medical necessity is the ultimate driver in the evaluation and management services.

For procedural services reviews, MHC’s certified coding clinicians review for accurate procedural coding based on procedural or operative note documentation and comments if unbundling of services (upcoding - an area where entity may be at risk for fraud) or missed reporting of additional procedural services based on documentation (downcoding - an area of potential loss of revenue for the entity) has occurred.

Following preparation of the individual physician audit “report card” highlighting the summary findings of the audit results, our one-on-one or group session training process serves to quickly provide immediate feedback on his/her documentation issues. And, as you perform more documentation audits, it will be important to “trend” your findings.

For providers with material coding deficiencies, our ongoing training regimen provides the opportunity to rapidly achieve required coding accuracy. This is coordinated in conjunction with client’s compliance program and compliance score goals.

MHC audits retrofit nicely with the client’s existing or developing compliance programs. Audit results are clearly documented and regulatory sites are well documented. Many times audits are performed under the auspices of external legal counsel, thus providing a modicum of client privilege to results. Typically, our physician coding and documentation audits include:

A minimum of fifteen (15) chart audits per provider, prepared using the OIG / AMA protocol for such audits
Individual physical/advanced practitioner audit “report card.”
Executive Summary Report for hospital administration and, when appropriate, legal counsel.
On-site educational sessions and, when appropriate, telephone educational sessions.

We assist our clients with two common types of audits:

External Standard Audit: Part of client’s ongoing compliance program initiatives-auditing, monitoring and educational component. These independent external audits should be conducted at least once a year or once a quarter as a part of the ongoing compliance program initiatives. MHC works with the designated individual(s) at client’s sites to select a material sample of each provider’s high volume (dollar and/or units) patient service.

External Target Audit: At times, the client may have specific areas of concern based on a general internal audit, denials received or updates from Medicare or other third party payors. These types of audits are best conducted under the auspices of external legal counsel.

Millennium Healthcare Consulting, Inc’s ®, in association with our strategic partner IMEDECS, is the independent Billing Dispute External Review Board (BDERB) under settlement agreements between the plaintiff physicians and medical societies and several health plans. Under the settlement agreements, the health plans have established an independent review process for disputes with physicians over application of certain insurance company’s coding and payment methodologies. Details of the settlement are available at www.hmosettlements.com.