Compliance education is mandatory and is conducted regularly to promote compliant behavior. Special attention is given to compliance and quality in the documentation, coding and billing of professional services. Educational efforts address identified risk areas in physician billing practices and promote preventive policy. The Audit, Compliance & Education (ACE) department ensures that billing rules, guidelines and policy are disseminated to timely. One of the many services provided in support of compliance education is an ‘Ambulatory 10 chart Review’ on all new ambulatory providers.
A 10 chart review is performed by ACE for all Ambulatory providers providing outpatient services, who are not receiving CU Medicine coding oversight, 3-4 months post start date if volume allows. New Providers will be advised at the time of their CU Medicine orientation that a review of their outpatient documentation will be conducted approximately 3-4 months after they begin seeing patients. The ACE Auditor will select a sample of 10 outpatient encounters to review. The sample will include a variety of levels and any procedures billed with these levels of service. All related documentation from the sample will be reviewed using CMS and MAC requirements. Once the review is completed the provider will be contacted via email to set up a 30 minute review session which can be completed by phone. The review findings will be discussed at this time.
Pass/Fail – A provider is determined to have passed if there is less than 12 points and less than a 20% average collection error rate. This is determined by the Audit Process weightings. If a provider receives a fail weighting the Auditor will contact the provider to set up a review session which can be completed by phone. The review findings will be discussed at this time. The provider will then move to a Re-Review status and will be reviewed again 1-2 months after initial contact and education. If the Auditor is unable to contact the provider after two attempts, a written summary may be sent via email to the provider.
If there are not enough encounters to perform a 10 chart review then the provider will be moved to the next month’s review. If after 3 monthly attempts there is not enough charge activity the provider will not be provided a 10 chart review and will then be added to the formal department/division audit review as scheduled.
If charge corrections need to be made after the provider review session, the ACE Auditor submit the charges.
For special requests: