PPR staff conducted a baseline coding audit for a large physician group. This review included over 5000 encounters and focused on services provided in the hospital setting (outpatient and inpatient), including but not limited to evaluation and management and surgical procedures. Upon completion of each review, we provided immediate education to each provider that fell below established coding accuracy rates. Further, we provided executive summary reports with recommendations for each provider audited. The specialties covered during this review included: Cardiothoracic Surgery, Emergency Department, Endocrinology, General Surgery, Internal Medicine, Mid-level Providers (working under incident to guidelines), Obstetrics and Gynecology, Pediatrics, Psychiatry, and Urology.
We conducted a revenue cycle process analysis of a medium sized physician group. The tests performed during this analysis consisted of all processes of the revenue cycle from patient to payment. Based on our assessment, we provided education to staff and developed policies and procedures.
Our staff worked as the auditor for a company that was engaged as the Independent Review Organization (“IRO”) by an ambulance company to perform an analysis of services and to assess the effectiveness of the ambulance company’s compliance efforts in relation to terms of its Corporate Integrity Agreement (“CIA”). The CIA was mandated by the OIG pursuant to the discovery of certain billing and reimbursement violations. We conducted an analysis of a random sample of 50 ambulance claims to determine the accuracy of the facility’s claims. Our findings were communicated to the OIG via a written report.
Education and Training
Our CEO, Lisa Campbell, PhD, MHA, MPM, RHIA, CDIP, CCS-P, CCS, CPC, COC, CPC-I, has been providing education and training services since 1997 and is an adjunct professor for several colleges and universities. Further, she has spoken at the local, state, regional and national level for the following organizations: The American Academy of Professional Coders (AAPC), The American Health Information Management Association (AHIMA) and the Health Care Financial Management Association (HFMA). Lastly, she recently co-presented an audio seminar on “Modifier Usage in Professional Fee Services”, for the American Health Information Management Association. This seminar provided an introduction to modifier usage, review of problematic modifiers and clinical examples that demonstrated proper modifier usage.
We conducted an operational assessment for a physician group that focused on all day to day operational areas of the physician’s practice. Upon completion of this assessment, we developed an action plan of areas that needed improvement and are currently assisting with implementing these recommendations.