According to the U.S. Department of Health & Human Services, 42 percent
of claims are coded incorrectly.
Medical Chart Auditing
In the healthcare industry, medical chart auditing implies being on the same track with the documentation/compliance requirements and relevant federal/state regulations. Audits are an invaluable tool to your organization since they may directly influence your reimbursement flow. Internal medical record auditing services can be used to assess various aspects of your organization’s internal clinical reporting approaches.
If you want to ensure that your organization is following the stringent regulations laid out by the government and healthcare payers, then you need to take advantage of WCH’s medical record auditing services. This comprehensive service involves a rigorous review of the charts you make
Importance of Regular Medical Record Auditing
WCH recommends that you schedule medical record auditing services at least once per year. Internal auditing is essential if you want to protect your organization from undue liability, prevent extensive inquiries into your billing practices, and avoid potential penalties.
Regular audits also offer several other substantial benefits, which we’ll explore in depth below. Reading more
Identify and Eliminate Coding Errors
Coding errors are one of the largest sources of waste and lost revenue for healthcare providers.
Medical record auditing services from WCH can help you identify and eliminate many of these frequent coding errors. Our experts can detect patterns of downcoding or upcoding, both of which could negatively impact your business.
Downcoding is particularly costly because patients are not properly billed for all services that they receive. At the same time, consistent upcoding can also prompt private insurance companies or the federal government to request an audit which may result in a liability imposed on a healthcare provider.
Depending on the severity of the errors, authorities may also request a criminal inquiry and formal investigation.
Medical report auditing is a proven method of protecting your business from the serious consequences of coding errors. Our team has an extensive knowledge of state and federal healthcare regulations, as well as the requirements set forth by major insurance providers. The auditor(s) assigned to your account will thoroughly review all relevant data so that you can proactively address coding errors.
Protect Against Fraudulent Billing Claims
Due to the complexity of the modern healthcare system, fraudulent billing claims have become a serious problem that organizations must contend with. These claims will ultimately impact the provider, the patient, or both.
WCH’s medical record auditing is an effective means to insulate your organization from the dangers of fraudulent billing.
Much like incidental coding errors, a pattern of fraudulent billing claims can make your business the subject of investigations and audits. If violations are discovered, substantial fines may be levied against your organization and individual providers. This can cause significant damage to your reputation while also dramatically impacting profitability.
Fortunately, you can mitigate these risks with WCH’s auditing services.
Reveal Inconsistencies with National Averages
As a healthcare provider, your primary concern is providing exceptional care to your patients. However, you may not be able to effectively accomplish that mission if your business has inconsistent billing practices that put it at a financial disadvantage.
Medical record auditing not only protects you from fraudulent activity, but it can also be used to reveal inconsistencies with national averages.
Correct Shortcomings before Government or Healthcare Entities Challenge Coding
With the ever-changing regulations in the modern healthcare industry, it is vital that your organization undergoes regular medical record auditing.
Healthcare payers and governmental agencies are conducting their own audits with increasing frequency. If you are not conducting your own internal audits to prepare for these investigations into your billing practices, then you are setting yourself up for failure.
Protect your practice with WCH’s auditing services
Accurate coding and compliance paired with required documentation can directly affect your practice’s income. Our services can help you maximize revenue by reducing claim denials while also insulating you from the liability associated with record-keeping errors.
Prevent Extensive Auditing Investigations
If an external audit reveals inconsistencies in your coding and billing practices, then integrity contractors may come knocking.
These contractors are tasked with conducting a more thorough investigation into your practice. An investigation can take weeks or months and disrupt the flow of your daily operations.
Depending on the results of the inquiry, you may be subject to significant recoupments, or lose out on insurance plan participation with your practice.
As you know all too well, even losing out on a single contract can cost you thousands of dollars and force your patients to seek care elsewhere.
If you want to avoid being the subject of these extensive investigations, take advantage of WCH’s medical record auditing services.
Experience: Professional and successful work since 2001;
Safety: Certified professional auditors. Work with lawyers. Go to courts.
Professionalism: National industry recognition and certifications from AAPC, AMBA, AHIMA, HBMA, HCCA, PAHCOM, BBB and OIG, OMIG compliant;
Education: Extensive education for your staff;
- Readiness for insurance companies’ audit;
- Increase revenue. Eliminate unpredictable penalties.
Result Full report with proof, valid for insurance audits;
- Posted, partially paid and denied claims
- Claims affected by multi-procedure reduction
- Frequency of resubmitted claims
- Patient billings and copayment collections to ensure compliance with payers, state and federal laws
Analyze Recommendations to improve systems and practices
- Unclean claim percentages
- Loss due to excessive claim resubmissions
- Legal implications of undercoding and overcoding
- Lost revenue uncovered due to coding, recordkeeping and submission errors
- Front office training to ensure proper authorization and eligibility checking.
Fees: Professional Fees: $ 120.00 per hour. A detailed invoice will be provided at the time the review is complete.
Tel.: (425) 463-9131
of expertise includes:
Why do I need an Audit?With today's ever-changing regulations and high frequency of audits from governmental and other healthcare payers, the internal Audit is the vital process that every practice must undergo. It is recommended that medical practices conduct internal Audits at least annually to confirm compliance with the coding guidelines and documentation requirements. Protect your practice. Accurate coding and compliance with documentation requirements and healthcare payers guidelines directly affect your practice's income.
What is included into the WCH Auditing Services?Auditing Services as per Client's request may include the following:
• Identification areas of risk leading to upcoding or downcoding in the documentation and medical coding accuracy;After the completion of the audit service, we provide a written report to the Client, setting out the findings, recommendations, and audit opinion arising from the Audit.
• Verification that coding practices are compliant with the regulations set forth by private and government payers;
• Education of providers and staff on how to use documentation to maintain HIPAA compliance;
• Complete Chart Audit;
• EMR Coding/Documentation Review;
• Review compliance with the Incident to guidelines and services performed on collaborative premises;
• Analysis of Denials/Duplicate billing /Appeal process (Pre-payment and Post-payment)/Modifier usage;
• Review of format and content of the health record as well as other forms of medical/clinical documentation;
• Coding, including ICD-10-CM, CPT, HCPCS;
• Analysis of billed claims, including the UB-04, the HCFA 1500, charging procedures;
• Review compliance with the State and federal regulations concerning the use, disclosure, and confidentiality of all patient records;
• Front Desk work review including but not limited to: Eligibility verification/Benefit maximums verification/Excluded services verification/Authorization process/Patient responsibility (deductibles, copays, coinsurance)/Coordination of benefits;
• Verification if any abusive billing or fraud exists;
• Insurance plans participation and consistency of contracted rates;
What is the fee for Auditing Services?The professional fee for Auditing Services is $ 120.00 per hour. The Auditing Services Agreement includes a retainer fee of $1,000. A detailed invoice is being provided at the time the review is completed.
Should I get a Second Opinion on My Billing for Profitability, Protection, and Peace of Mind?
Are you confident your staff or billing service is capturing 100% of your reimbursements? Probably not. In fact, practices lose up to 66% of their revenue annually due to coding and billing errors.
Now, there's an easy way to find out. Get a WCH Second Opinion.
WCH Second Opinion Internal Billing Audit Service is a quick and low-cost verification process that immediately identifies coding errors, recordkeeping issues and potential liabilities. Most importantly, WCH Second Opinion pays for itself by uncovering missed revenue opportunities.
Will A Second Opinion Help Increase Practice Revenue?
If your claims are being denied, you could be leaving many thousands of revenue dollars on the table every year. A WCH Second Opinion helps multi-location, multi-specialty practices and single office providers analyze billing practices, identify errors, and make changes to regain revenue.
Can I Audit Both Outside Billers and Internal Management?
Every medical practice should be auditing its billing practices annually. Coding errors, inadequate record keeping, incomplete submissions, and illegal shortcuts leave a practice vulnerable for an insurance audit. Make sure everyone involved with billing, both internal staff and outside vendors, is staying up-to-date, keeping comprehensive records and complying with the latest rules and regulations for each insurer.
How does this Benefit our Practice?
An expert second opinion will ensure you are maximizing revenue and minimizing common mistakes that could result in suspension of insurances or a medical license.
U.S. medical practices forfeit nearly $125 billion annually due to inadequate
WCH reviews and processes tens of thousands of Medicare, Medicaid and private insurance claims every year. We know that billers without APPC and HBMA certifications frequently make mistakes due to lack of knowledge or carelessness that deprive providers of income because we see it every day.
Take advantage of our expertise and Get a WCH Second Opinion to ensure your in-house or other billing service is complying with changing rules and regulations and receiving maximum reimbursements. We will pinpoint deficiencies, recommend solutions, or confirm everything is on track.
for all types of practices, large and small, for more than 20 years. To find out more about our services: