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OUR
LAYERED APPROACH - QUALITY
ASSURANCE
Random audits protect your practice and maximize revenues
by continually identifying improvement areas. It is
for this reason our Quality Assurance department audits
all aspects of billing and reimbursements.In addition
to providing management oversight, quality assurance
scrutinizes your account's performance, ensuring compliance
with federal and state mandates as well as ensuring
that maximum reimbursements are realized.
Each account is audited on a random basis with all elements
of the account being assessed:
BILLING · Account
representatives are tested regarding specific billing
instructions and requirements
CODING · Assigned
codes are compared to industry standards verifying correct
assignment and utilization
DATA ENTRY · Information
is assessed for accuracy
COMPLIANCE · An
assessment is made to ensure that all federal and state
regulations are adhered to thus protecting your practice
from fraud and abuse allegations and to confirm that
information updates are made to carrier information
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Your
team continues to function during this process; there
is no interruption of the workflow. Audits are kept
on file by account and are available upon request. Quality
Assurance is a department that you may never see - but
you will be grateful it exists.
QUALITY ASSURANCE AUDIT PROCEDURES: The Quality
Assurance department was formed to ensure accuracy,
guarantee compliance to reimbursement policies and process
provider enrollees in the most efficient and cost effective
manner.
Quality Assurance audits are based on Medicare Part
B, Medicaid and Blue Cross/Blue Shield Billing Procedures
and Guidelines. We continuously identify areas of improvement
and track our performance through written audits. The
audit process is performed at random. The audits review
demographic information, charge sheet documentation,
insurance and unbilled insurance reports, CPT and ICD-9
codes, explanation of benefits for underpayments and
overpayments, denials and/or rejections, electronic
filing, and correspondences associated with the medical
services rendered.
All areas requiring improvement are identified and documented
on the audit form and forwarded to the responsible manager
for action.
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