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Audit Services - Physician Office Support
Claims Review
The goal of the physician office billing review is to evaluate the coding and
billing practices, policies and procedures used in billing professional charges
assuring that claims meet federal and state regulations. Custom audits are
designed as requested.
A QMCG reviewer will interview office staff involved in the billing process
and review a representative sample of claims submitted to government payers. The
bill is reviewed with the medical record to assure that the documentation
supports the ICD-9-CM diagnosis code, the appropriate Evaluation and Management
(E&M) code, the appropriate HCPCS/CPT code for any procedures performed and
modifiers if indicated. The review also includes an audit to determine that the
billed service was provided. The bill is further reviewed to assure that the
charges are bundled/unbundled per CPT and government regulations. A report is
submitted which discusses the findings of the review and notes any concerns
along with providing recommendations to assist with billing in compliance with
the government regulations.
A report detailing the findings of the audit is submitted to the office.
Physician Office Educational Program
QMCG often tailors education programs specific to the specialty practice of a
particular office. However, the following are issues most often requested:
- "Incident to" billing;
- Advanced Beneficiary Notices and Local Coverage Determination;
- Evaluation and Management codes;
- Consults versus visits;
- Bundling/unbundling;
- ICD-9-CM coding updates;
- Modifiers;
- Care Plan Oversight codes;
- Billing Preventive Services.
Intermittent Consultation Service
QMCG professionals are available by email, fax or telephone to respond to
office staff questions concerning coding and claims submission issues - a
different level of "help desk". The service is charged in 15 minute
increments and responses are most often accomplished by copies of supporting
documentation. To become an on-going consultation client, contact QMCG by
telephone at (614) 227-4848, by fax at (614) 227-2390 or by email at info@qmcg.com.
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