Hi,
I need to develop an internal policy on charge capture for daily charges and would love to see a few examples if you'd like to share. This is for an Infusion Center (hospital based).
Thanks
Traci
traci.susong@gmail.com
For prospective reviews, we have a person who is responsible for screening our electronic claims, and we have her hold all of the claims for the providers being reviewed, for a day or so. Once we've got a list to pick from, we pull a representive sample of their average code utilization, so if 30% of their claims are 99214's, and the other 70% are 99213's (for conversation's sake), then we'd pick 3 99214s and 7 99213's to review, and we'd release the rest of the claims.
For retrospective reviews, we compare utilization patterns against CMS national stats for the same specialty, and pull claims where they are identified as outliers, since those pose the greatest risk, and have the highest potential for error. We use software called Anodyne Analytics to find the most frequently billed codes for each provider.
You'll either need software that has the same types of reporting functions as Anodyne, or the ability to run custom reports with your current billing software...You can also buy audit software that comes with national stats pre-loaded - but if you'd rather not spend the extra money, you can find the info here:
http://www.cms.gov/MedicareFeeforSvcPartsAB/04_MedicareUtilizationforPartB.asp
You've got to calculate the percentages yourself, though, and there's not anything newer than 2008 available, but it's better than nothing! Hope that helps!
