Are you a health care provider with denied claims that you can't get paid? Have you been the target of a recent audit by Medicare or other
private insurance company? Are you confused by the ever changing rules of the insurance industry when it comes to getting paid for your services?
Are you concerned that you may be undercoding or not coding correctly, reducing the potential income you could be earning?
If so, we can help.
Health care providers today face a bigger challenge today than ever before when it comes to being paid for their services. Medicare reform is
a hot topic, and calls for reform and cost-cutting will only continue to get louder. Private insurers are under pressure with rising costs, and are
looking for ways to save money as well, creating a constant battle between provider and insurer.
According to the Department of Health and Human Services in a 2005 special report, 30% of all health claims are denied, with poor coding the
leading cause. A staggering 50% of those denied claims are never resubmitted. Other impacts of poor coding include increased costs for compliance,
lost revenue opportunities, poor cash flow, and compliance and financial risks for violations.
Medical coding will only continue to get more complex as well with the upcoming ICD-10 migration, PQRI, yearly coding changes and quality
reporting changes.
More than ever, the quality of the coding that you do on your claims and how you submit those claims can make the difference between getting
fully compensated for your services or not. Unfortunately, most health care providers don't have the time to keep up with the constant flow of
information. Professionally trained certified coders can cost a premium, and it is not always practical to keep one on staff.
WHAT IS THE SOLUTION?
Profast Billing's Audit Guard service can catch errors in coding before government or insurance auditors do. We provide access to over 250
certified coders in 32 medical specialties. Each coder has at least 3 years experience and has been screened for quality of work. All are AAPC or AHIMA
certified.
Our Audit Guard coders will do a complete review of your medical charts ( usually 25-50 ) then provide you with a detailed finding as well as a 30 minute
phone interview with the coder that was assigned to do your review. This audit review/report will help you identify these commone risk areas identified
by the OIG:
Billing for items or services not provided
Submitting claims for equipment, medical supplies and services that are not reasonable and necessary
Double billing for the same service or item
Misuse of provider ID numbers
Unbundling a multiple components service and billing each component as a single service
