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Garfunkel Health AdvisorsGarfunkel Health AdvisorsGarfunkel Health Advisors

Documentation and Coding/Audit

Documentation & Coding Audit Services

Our documentation and coding audits are designed to identify coding and documentation issues that may affect reimbursement and/or raise compliance risks.  Through a comprehensive assessment of documentation, coding and billing practices, our recommendations are intended to help providers take appropriate corrective action and ensure compliant practices.  GHA offers a variety of audit services and approaches to suit the needs of your organization, including:

PROFESSIONAL PHYSICIAN SERVICES

Office encounters, including a review of E/M, CPT, and ICD-CM coding
Surgical encounters, including general surgery, endoscopies, anesthesia & pain management
Complex cases, including surgical assists, interventional radiology, cardiology, radiation/infusions, vascular and neurosurgery, and/or the additional of clinical documentation protocols

HOSPITAL INPATIENT SERVICES (INCLUDES HOSPICE, SNF, LTC, BH, OBS)

Review of ICD-CM, ICD-PCS and DRG
Patient Driven Payment Model (PDPM ) accuracy reviews and education

HOSPITAL OUTPATIENT & ASC SERVICES

Surgical services including general surgery, endoscopies, anesthesia & pain management
Patient Driven Payment Model (PDPM ) accuracy reviews and education
Complex surgical services including interventional radiology, radiation/infusions, cardiac catheterization, etc.

EMERGENCY DEPARTMENT PROFESSIONAL /FACILITY 

Review of ICD-CM, E/M and CPT coding

FQHC SERVICES

Review of ICD-CM, E/M and CPT, behavioral health and dental coding

TELEHEALTH & REMOTE PATIENT MONITORING SERVICES ***

All services- documentation & coding compliance, consent, modifiers, other risk areas
Risk assessments

CODER & AUDITOR QA

External coding & audit quality assurance reviews and education

RISK ADJUSTMENT / HCC

Review of patient medical records for all ICD-CM and HCC coding

MEDICAL RECORD CONSULTANT PROGRAM

Article 28 DT&C/ ASC medical record compliance assessment
Assist ASCs in meeting their Federal and State medical record documentation requirements

OTHER

Custom coding & auditing support services

GHA will help your organization determine the most strategic and efficient approach for its audit and compliance needs.  We routinely work with attorneys to prepare deliverables under the attorney-client privilege, which ensures that our clients have the benefit of legal expertise to help navigate complex situations.  All GHA auditors have a minimum of five (5) years of coding and audit experience, and are required to be Certified Professional Coders (CPCs), Certified Risk Adjustment Coders (CRCs) and Certified Professional Medical Auditors (CPMAs).  Our auditors also undergo rigorous pre-employment testing and ongoing monthly qualification reviews. 

In order to ensure quality control of each project, GHA matches the expertise of the coder or auditor to the medical specialty under review.  In addition, we utilize a two-tier review process: after the primary audit is completed, the results are sent for a secondary review by a senior auditor.  This provides a multi-layer review to help ensure that audit findings are complete and accurate.  GHA also has the ability to create a variety of custom reports to suit your organization’s needs.

Depending on the type of engagement, audit deliverables typically consist of the following:

Descriptive Summary of Findings
Quantification of Errors
Recommendations for Corrective Action

GHA will work closely with leadership to facilitate completion of the project and schedule a time to review deliverables.  

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