Encounter Auditing

Are you maximizing your reimbursement for the services that you are providing? Do you fear an insurance audit may result in a negative outcome, leading to a significant financial penalty? Are your in-house guidelines current?

Our experts will analyze and identify your practice’s weaknesses and short-falls with our chart review system and in return, strengthen your practice. If you have a focused concern, we will target your specific items. We believe every practice has an individual philosophy, and because of this we will help you reach your required compliance goals.

Medical Record Review – Our auditors will review your medical records and determine the accuracy of billed services. Each provider will be critiqued on all elements of their documented history, physical examination and medical decision making. Additionally, we will review your choice for ICD diagnoses and CPT service codes.

We will highlight which areas your providers are omitting to ensure they will be better insulated from an audit. Conversely, we will determine if your providers are over-documenting and indicatehow they can save precious time in their daily routines or perhaps choose a higher level of billing if appropriate. Our reports will be provided to your administrator for review and we will discuss the results to ensure proper interpretation.

Missed Charge Opportunity (MCO) Revelation – There are over 1,000 pages of available services and procedures across CPT and HCPCS. This list of procedures changes every year. Insurance companies pivot quarterly on which codes they will reimburse. We will review and reveal which codes you can submit for services being performed! This will raise your ceiling for future reimbursement.

Insurance Audit Appeals – If your practice is audited and receives a negative outcome, allow our team to determine if you have a case for an appeal. Payors often make mistakes during their audit process. The DMS coding staff will construct the appeal on your behalf. We will advocate your position with all of the necessary documentation to support the appeal and stand behind you every step of the way.