Help! Medical record audit company by physician

Metroderm

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I need a help finding an medical record audit company that has an auditor who is a physician.
Is there any company that a physician audits medical records.
Please help.
 

haraml7

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I know there are peer to peer options, but this is for appeals if the insurance keeps denying the claim a peer to peer can be requested on the providers behalf. I don't know of any specific companies that have a provider specifically that audits records, there may be some out there. Is this for a certain kind of audit that needs to be done? you can PM me if you would like.
 

Metroderm

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I know there are peer to peer options, but this is for appeals if the insurance keeps denying the claim a peer to peer can be requested on the providers behalf. I don't know of any specific companies that have a provider specifically that audits records, there may be some out there. Is this for a certain kind of audit that needs to be done? you can PM me if you would like
Actually it's for our provider education purposes. They won't listen to any other people's advise except MD. We need a physician who can review our provider's note and give an advise. Also, we need to know if our providers are documenting correctly. I'll talk to my supervisor and contact you if necessary. Thank you.
 

tmorgan808

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A peer to peer review might be from a quality standpoint vs. a coding standpoint. We have this discussion at work all the time. The providers need to understand that they may think their documentation stands up to a quality of care review, but in order to get paid they need to meet certain documentation guidelines.
 

amyjph

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Actually it's for our provider education purposes. They won't listen to any other people's advise except MD. We need a physician who can review our provider's note and give an advise. Also, we need to know if our providers are documenting correctly. I'll talk to my supervisor and contact you if necessary. Thank you.
I have found it helpful to do internal peer to peer audits in this situation. For example if you have a number of providers of the same sub-specialty they can each take a sample and share their findings. There are external companies that will come in and do an external audit but it may be very difficult to find one that has physicians performing them. You could also look to the specialty societies and groups such as AAFP, AAOS, ACOG, ACP etc. Most or all of these have reimbursement and practice management sections and they may be able to help. Depending on your provider type they are most likely aligned with one of these type groups and already have access to the information and resources. Another option is contracting with a clinical documentation improvement group who may have Nurse Reviewers.
 

niharims

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A peer to peer review might be from a quality standpoint vs. a coding standpoint. We have this discussion at work all the time. The providers need to understand that they may think their documentation stands up to a quality of care review, but in order to get paid they need to meet certain documentation guidelines.
where do you find these certain guidelines as I am also looking for the same for internal Audit.
 
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