What to Expect & How to Decide What's Best For You
Average Audit Sample Sizes
Clients determine the sample size, but often ask for our input.
Average Audit Sample Sizes
Clients determine the sample size, but often ask for our input.
Our Full Team Approach
We’re all in. Full support. No matter the size.
Our Full Team Approach
We’re all in. Full support. No matter the size.
Most Common
Specialties Audited
We ensure specialty diversification to meet our clients needs. Within each specialty, our expertise exceeds the ability to evaluate E&M services, including office based procedures, diagnostics, surgical services, diagnoses, and ancillaries appropriate to the specialty. Our team routinely engages in the following specialities. Client references are always available upon request.
Most Frequently
Requested Audits
This listing includes the most frequently requested auditing services by our clients in no particular order. We are able to accommodate many other audits and specialties not included in the listing.
Most Common
Specialties Audited
We ensure specialty diversification to meet our clients needs. Within each specialty, our expertise exceeds the ability to evaluate E&M services, including office based procedures, diagnostics, surgical services, diagnoses, and ancillaries appropriate to the specialty. Our team routinely engages in the following specialities. Client references are always available upon request.
Most Frequently
Requested Audits
This listing includes the most frequently requested auditing services by our clients in no particular order. We are able to accommodate many other audits and specialties not included in the listing.
A Deeper Look at Our Auditing Services & Process
Why should you consider NAMAS?
We are an auditing firm. Organization auditing services and chart reviews are the fundamental core of our business, which gives our audit team an advantage of maintained focus.
Is an organization REQUIRED to perform annual coding and audit reviews?
The Federal Register, at this time, indicates that this “is a requirement”, but goes on to state however the effective date of that requirement will be determined.
Why should you perform an audit/review?
A proactive approach is always better than reactive response from a carrier and that is the answers an internal review should provide. Performance improvement AND performance proficiencies of the organization within coding and documentation and when information is provided appropriately- billing. Some state Medicaid programs, REQUIRE audit/reviews of each enrolled provider.
Regarding the OIG (Office of Inspector General) , an annual review of your practice’s coding and documentation is strongly recommended by the OIG as part of an effective compliance program. In addition, a coding audit will help:
- Identify areas of risk leading to over or under coding and documentation and of course under documenting by the provider (or over coding) as well
- Ensure that your coding practices are compliant with the regulations set forth by private and government payors
- Teach your providers and staff how to use documentation to maintain compliance and proper reimbursement
Frequency of Audits & Reviews: The recommendation by the OIG and the requirement by many state Medicaid plans is annual reviews
The Audit and Review Process: Post-COVID more reviews are conducted remote, but our services can be rendered onsite.
- Timeline varies by project size, however typically a 10-provider documentation audit review has a turnaround time of ~14 business days
- All projects begin with a kickoff call in which our team begins to know the client needs more intimately. While these were discussed during Scope of Work creation, it is imperative the specifications are reviewed with those tasked with day-to-day operations.
- The Client selects the sample for the audit review, although our team is happy to assist. The Frank Cohen Group is available to contract for full sampling if needed
- Review of the record is performed through secure data exchange or EMR access
- Large volume projects findings are uploaded upon completion for Client access, rather than upon project completion. This allows real-time access to audit review findings. A HIPAA complaint repository, ShareFile, will be provided to the Client for report sharing and data exchange
- Each Scope of Work varies by customization, however NAMAS promotes provider feedback of the audit review findings. Without feedback, and audit is a mere paper exercise. Whether group or individual, the training will now be coordinated
Precision Ratings: CMS & the OIG have made references to the fact that our providers should have 90-95% correct coding, however, NAMAS will honors the precision rating of each organization’s Compliance Plan. (The precision rating being the “pass/fail score” for compliance determinations.) The goal is to have a post audit plan using the precision ratings.
Post- Audit Debriefing Implementation Strategy: This is a critical part of the audit review process. Our team will recommend best practices and how to correct identified deficiencies detected during the upcoming months with or without our team’s assistance, whichever works best with the organizations budget. The plan is part of the audit. Therefore, it is most important that the audit findings are discussed and reviewed in detail with the budget coordination, compliance operations, and provider management.
Our Auditors: Our team has 10+ years of audit specific experience at senior level management. The expertise of our team is so specified that we even perform expert witness and work with health law attorneys on audit take back appeals. NAMAS auditors are dually credentialed as Certified Professional Medical Auditors (CPMA) and Certified Professional Coders (CPC) . Our auditors perform more than 2000 unique coding and compliance audits annually for medical practices and facilities around the country and overseas.
Other Services: Accompanying our organization auditing services and chart reviews, NAMAS does provide coding services, consulting, ask the auditor, credentialing, appeals, expert witness, our annual conference and much more. However, audit services is the core service line, second to education of our members.
A coding audit is a comprehensive review of your coding, billing, documentation and reimbursement process. Who better to perform your coding audit than the only nationally recognized trainer of medical auditors; NAMAS.
NAMAS auditors are dually credentialed as Certified Professional Medical Auditors (CPMA) and Certified Professional Coders (CPC) and each auditor has a minimum of 15 years’ experience. Our auditors perform more than 2000 unique coding and compliance audits annually for medical practices and facilities around the country and overseas.
The reason for performing a coding/documentation audit is compliance. An annual review of your practice’s coding and documentation is recommended by the OIG (Office of Inspector General) as part of an effective compliance program. A coding audit can help ensure that you are receiving appropriate reimbursement for all the services you provide. In addition, a coding audit will help:
- Identify areas of risk leading to over or under coding and documentation
- Ensure that your coding practices are compliant with the regulations set forth by private and government payors
- Teach your providers and staff how to use documentation to maintain compliance and proper reimbursement
Coding audits can be performed remotely or at your location. A NAMAS auditor will review a random selection of charts to identify trends in your coding practices that may be costing your practice money or putting your practice at risk. Our comprehensive coding audits include an evaluation of the practice’s fee schedule, modifier usage, CPT/ICD coding, provider documentation, EOB denial trends, and productivity levels for Bell Curve analysis. Your NAMAS auditor is proficient in the rules and regulations enforced by Medicare and commercial payors. Your NAMAS auditor will also identify coding and billing practices that could increase efficiency and overall revenue.
Implementation is critical and your NAMAS auditor will recommend best practices and how to correct identified deficiencies detected during your review. Therefore, it is most important that the audit findings are discussed and reviewed in detail with each provider, including physician assistants and nurse practitioners. Education to ensure improvement of the noted deficiencies is paramount to the overall success of the audit. Our auditors will communicate the methodologies used during your audit. A NAMAS auditor will also spend time with each key staff member such as medical and surgical coders to provide hands-on training and feedback to ensure they are equipped to assign the most accurate codes that are in the best interest of the practice.
To inquire about our organization auditing services and chart reviews, please email namas@namas.co or use the form below.
Contact Us Today to Discuss Your Audit Plan
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