Posted and filed under Medical Record Auditing, Payers.

The Claims Denial Epidemic

The American Hospital Association recently released the results of a survey conducted to explore the efficacy of the RAC program in hospitals nationwide. The survey utilized the results responses submitted by 676 participating hospitals in order to explore the program’s impact in the second quarter of the year 2016. The results suggest that while Medicare…

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Posted and filed under Medical Record Auditing.

Staying Productive in Gale Force Winds

Hurricane Matthew flooded headlines earlier this month as it approached Advize Health’s home-base of Tampa Bay, threatening to eliminate power-lines and productivity. The threat of the storm had the Advize Health team working in overdrive, strategizing ways to stay safe and effective while hunkering down. With the power flickering and winds picking up, Advize Health…

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Posted and filed under FWA, Medical Record Auditing.

The Great Divide: Federal vs. Commercial Health Plan Reviews

Commercial Health Plans The act of tailoring medical record audit procedures to the needs of a particular health plan is not a novel concept. Different commercial healthcare payers maintain requirements unique to their served populations, and audits are consistently slightly augmented in order to focus on E/M, specific and proper modifier usage, and other various…

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Posted and filed under Coding, FWA, Medical Record Auditing.

How Much Are Your Policies Costing You?

A medical record audit can reveal over-payments for up-coding, incorrect numbers of units billed, and the abuse of modifiers – just to list a few. Given the popularity of such indiscretions, what is being done after the money is recovered? Do you intend on data mining again in six months, hoping that the provider will…

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Posted and filed under Careers, Medical Record Auditing.

Advantages to Utilizing an External Auditing Firm

External auditors, or auditors who work for external auditing firms, are often trained in a variety of specialties and have experience in auditing for many different payers, providers, and facilities. Hiring an external auditor is extremely advantageous because they are equipped with knowledge and experience that allows them to not only identify problems, but to…

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Posted and filed under Coding, Compliance, Medical Record Auditing.

Advize Health Meaningful Use and Security Risk Analysis Webinar Recap

On March 10, Advize Health held our fifth monthly webinar on Meaningful Use and Security Risk Analysis. For this webinar, Advize Health’s auditor Melissa Jewett presented with Don Waechter from Compliance and Remediation Services, LLC. Both Melissa and Don are highly qualified to deliver such an informative webinar; as Melissa is a Certified Professional Coder…

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Posted and filed under Medical Record Auditing.

The Importance of Medical Necessity in Medical Coding

Medical necessity documentation, or lack of it, is one of the most common reasons for claim denials. For a service to be considered medically necessary, it must be reasonable and necessary to diagnosis or treat a patient’s medical condition. When submitting claims for payment, it is the diagnosis codes reported with the service that tells…

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Posted and filed under Medical Record Auditing.

Front Lines vs. Behind the Scenes in the Medical World

The work performed by Advize Health is enacted with insurance providers and patients in mind. Protecting providers and patients from fraud, waste, abuse, and unnecessary use of money are among our priorities, and our team of auditors works hard to deliver the best results.   Every facet of coding and auditing is important, because the end…

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Posted and filed under Coding, Medical Record Auditing.
claims data

Auditing Claims Data: What Can The Data Tell You?

There are many techniques to extracting data that can range from reviewing claim line billing data to actual medical record reviews. Relying exclusively on the claims data to analyze and identify atypical billing patterns or potential red flags is always challenging. As auditors we all know that the value of the audit process is only…

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Posted and filed under Medical Record Auditing.