Chart Audits

Chart audits are a critical part of managing your revenue and ensuring mistakes are not being made that have a negative impact on your financial strength.

They are important for the following reasons.

  • To ensure completeness of the medical record
  • To determine the accuracy of the provider’s documentation in the medical record.
  • To identify under-documented services
  • To uncover lost revenue

An annual E&M chart audit is included when you outsource your RCM (link to outsourced RCM) to RCM360. We can also provide an E&M chart audit for a nominal fee.

If you are interested in a more in-depth analysis of charts, please email us at info@rcm360.net and we can provide more details on the ancillary services we provide to help you stay informed and focused on ensuring best practices are followed.

Revenue

The auditor will look for lost revenue due to improper coding and/or inappropriate billing to gain a higher reimbursement.

Areas for review include the following:

  • Underbilled services – compare medical record documentation with claim billed.
  • Overbilled services – frequency and upcoding – compare medical record documentation with claim billed.
  • Undocumented services – review chart documentation to determine if billed services are supported.
  • Denied services – determine why a code was denied based on documentation reviewed.
  • Services not billed or missed charges – compare medical record documentation with claim information.

Correct Coding Compliance

The auditor will look for documentation in the chart based on compliance standards for each payer.  Correct coding will help ensure a faster turn-around time and appropriate reimbursement for services provided.