AAPC - Advancing the Business of Healthcare

Medical Chart Reviews

Identify and remedy vulnerabilities - before they become liabilities.
Did you know our expertise includes inpatient ICD-10-CM and ICD-10-PCS coding, MS-DRG validation, outpatient ICD-10-CM, CPT©, HCPCS, APC, ED, E/M, and pro-fee coding in over 40 specialties.

How AAPC Can Help Your Organization

AAPC medical chart review services begin with a meticulous comparison of documentation to billed codes -and ends with helping you achieve accurate, liability-free coding that captures maximum reimbursement. Our comprehensive chart audit reviews will:

  • Identify areas of potential risk

  • Minimize claim denials and provider appeals

  • Defend against federal and payer audits

  • Ensure proper documentation that supports reported services

  • Discover overpayments and protect against false claims liability

  • Identify undercoding and reimbursement deficiencies

  • Improve your clean claims rate

  • Reduce rework and drive efficiency

Expertise for Your Organization

We provide prospective and retrospective multi-tier chart reviews conducted by a team built for your specialty, patient population, and place of service. Our expertise includes, but is not limited to:

Pro-fee Chart Reviews

  • 40+ specialties

  • 80+ sub-specialties

  • Hospital-based provider pro-fee visits

  • Emergency department visits

Hospital/Inpatient Facilities

  • Acute care

  • Behavioral health

  • Skilled nursing facilities

  • Hospice and home health

  • MS-DRG

  • APR-DRG

ASC/Hospital Outpatient

  • APC, surgical CPT®

  • Same-day surgery

  • Interventional procedures, injections, and infusion

  • Observation visits and diagnostic testing

  • Emergency department E/M

You're In Good Company

  • University Health
  • Kaiser Permanente
  • Namas
  • Orlando Health
  • Rady Children's
  • Experian
  • Deloitte
  • Dedi Clinic
  • Decision Health
  • Bon Secour
  • Craneware
  • Atlantic Health Systems
  • American Medical Association
  • Anesthesia Business Consultants

Trust & Transparency with Chart Review Technology

Our high-impact technology identifies upwards of 10% (on average) in missed revenue. When combined with our deep expertise, your organization is assured maximum financial gain in a streamlined process - that you can track from start to finish.

Customized Medical Chart Review Services

Focused Medical Chart Review

Our focused chart reviews provide reliable data to remedy claim issues involving sequencing, modifiers, or E/M reporting. Our focused audits target high-impact areas, such as:

  • Payer-focused reviews

  • Provider-focused reviews

  • Coder-focused reviews

  • Guideline-focused reviews

  • Medical necessity

  • CERT-identified/trending errors

  • Missed diagnosis codes

  • High RVU services

  • High volume services

  • High denial services and denial patterns

  • Undercoding

  • OIG and RAC target areas

Payer-Required Medical Record Review

In addition to taking on payer-required reviews, we also conduct preliminary reviews that improve accuracy for stronger negotiating leverage and a better financial arrangement with your payers.

Comprehensive Chart Review

Our comprehensive medical record reviews examine your coding and clinical documentation to identify errors and prevent denials at their points of origin.

Audit. Educate. Re-Audit.

Post-audit education and training is paramount to success. We can help your team improve reporting accuracy and keep pace with evolving regulations and payer guidelines. Based on your audit data, we work with your coding educator or directly train your clinicians and coding staff.

Your End-to-End Medical Chart Review Solution

We offer full-scale chart audit programs customized to your organization. When you rely on AAPC Services, you get subject matter experts with third-party objectivity, delivering optimal results:

  • Maximum reporting accuracy

  • Heightened productivity

  • Reduced A/R days

  • Unparalleled financial growth

DRG Validation Chart Review

Reduce DRG downgrades and denials. Our DRG validation audits will review your cases to ensure they're correctly coded, sequenced, and supported in the medical record.

Outcomes

A chart review program capable of reducing risks includes written policies that define reporting standards, as well as audit guidelines. We can assess your policies to ensure that controls are effective.Your dedicated audit team will be on hand to help you:

  • Determine if your policies are current and effective

  • Identify vulnerabilities in your audit plan

  • Draft controls to close compliance gaps

  • Explore issues related to electronic medical record templates

  • Investigate recurring problems, particularly root cause processes

  • Implement corrective actions, industry standards, and best practices

What Sets Our Chart Review Services Apart?

AAPC Services is a full-service organization with a reputation for excellence. Our track record of success is paved by medical auditors with vast experience and multiple certifications in coding, specialty coding, auditing, CDI, and healthcare compliance. And when it comes to the accuracy you depend on, we leave nothing to chance. Our quality committee evaluates every audit, as well as every auditor.

Additional Resources

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