Wiki chart review processes

[JRuybal]

Hello, I was told by someone that most companies do not do 100% chart review on the services they are billing for but process and bill the services and then audit a certain number of them periodically for compliance. Has anyone heard of this or do it this way? Currently at my job, the coding department reviews 100% of the documentation that we bill services for. I thought this was common practice but am now wondering if that is the case. We are under pressure to reduce the coding burden and I am hoping to get some insight into how other companies handle coding workflows so that I might get some ideas on how we can reduce our burden. I appreciate any info or input anyone would be willing to share.

 

[podcoder70]

This is a fantastic question and you are going to get various answers and opinions I am sure! I have been coding/billing for 20+ years and have found that the minute you stop reviewing records is when the document does not support the codes. While I understand the time involved, I am a firm believer in reviewing every document to properly code. Most physicians are not coders even if they think they are, no offense intended, their focus is and should be on patient care. They should be able to rely upon their coders to point out inefficiencies in a note and what is missing to support the codes they have provided. The "companies" and practices that are not doing this are setting themselves up for an audit failure.
My humble opinion...

 

[amyjph]

Yes, good question and you will get a variety of different answers. I have never heard of doing it the way you mention being told where everything just goes out and then post-bill audits are done. That seems really dangerous, a red-flag and scary. I think it depends very much on the size and type of practice, whether it is a large hospital, small group, etc. It is not mangeable, effective or efficient to do 100% manual coding of everything in my opinion. If it was a single provider office, maybe. It also depends on your EMR system and how charge capture is done. In my experience it has been a combination of automated claims billing after being run through an audit engine, edit review by a coder, catching rejections in the clearinghouse, 100% coding of surgery & procedures. From an office/oupatient E&M perspective I have experienced where we would review all audit target risk codes such as level 1 and 5, 25 modifiers, 59 modifiers etc. You have to look at your risk areas and take stock of how your documentation and coding is on the provider side. New providers should be on 100% audit and review before claims go out in my opinion.
This is a pretty loaded question and very dependent on the practice type and EMR system you are talking about.