PRACTICE RESOURCES > Coding and Reimbursement > Coding Review Services

Coding Review Services

A comprehensive review of a practice’s coding patterns and documentation provided by a trusted source such as the American Urological Association (AUA) is invaluable. The recent expansion of the Recovery Audit Contractor (RAC) audit process from Medicare to Medicaid and the provisions of the Affordable Care Act to increase screening of Medicare and Medicaid providers make the likelihood of government scrutiny much higher for all practices. Obtaining an internal evaluation of your coding and billing practices from AUA experts gives you an opportunity to get a preview of areas on which a government auditor may focus.

Scope of Services

Because of the disparate needs of various AUA practices, our service provides flexibility as to the extent of coding review services offered. We offer different levels of service at different prices depending on clients’ needs. Each engagement is custom designed for the Coding Review Services (CRS) client. After agreement on the scope of the engagement, the parties sign an engagement agreement and a Health Insurance Portability and Accountability Act (HIPAA) Business Associate agreement to allow access to private health information as necessary. The following levels of service are offered:

Level I — Risk review based on data analysis

This minimum service level includes a review of the practice’s billing data from reports generated by the client’s system. A series of Evaluation and Management (E&M) frequency graphs by individual provider compared to the national averages and identification of areas we deemed above average in risk would be included in a brief written report. The estimated time required to complete this review from date of receipt of the required data would be two business weeks.

Level II — Risk review and surgical documentation review

This service level would include all the steps listed above for Level I. In addition, an examination would be conducted of a sample of urological procedures based on the surgical or office-based procedure payment risks uncovered in the data analysis. Those operative notes would be reviewed, coded and compared to the codes billed by the provider. A written report followed by a conference call with the practice to discuss the results with all stakeholders would be provided. The estimated time required to complete this review from date of receipt of the required data would be 30 business days. This involves a two-step process for data retrieval. Level I data is received and the review is completed in two business weeks as specified for Level I. At the conclusion of the data review, a list of operative and/or procedural notes would be issued to the practice. The remaining 20 business days begins when the documentation requested from the practice is received and accepted as complete by CRS. These staggered deadlines would be clearly spelled out in the proposal letter.

Level III — Risk review and comprehensive documentation review

This service level would include all the steps listed above for Levels I and II. In addition, documentation of a small sample of E&M coding for each provider would be reviewed. A written report followed by a conference call with the practice to discuss the results with all stakeholders would be provided. The estimated time required to complete this review from date of receipt of the required data would be 90 business days. As mentioned in Level II, this involves a two-step process for data retrieval. Level I data is received and the review is completed in two business weeks. At the conclusion of the data review, a request for operative and/or procedural notes and a list of E&M documents (office visit notes, associated history and review of systems forms) would be issued to the practice. The remaining 80 business days begins when the documentation requested is received and accepted as complete by CRS. 

Level IV — Comprehensive coding review service

This service level would include all the steps listed above for Levels I, II and III. In addition, an on-site meeting would be provided with only CRS travel expenses as an added charge to the practice. The on-site meeting would include a coding educational session for selected staff members of the practice. In addition, during the on-site visit, the review team would conduct a review of processes and inspect documentation associated with Physician Quality Reporting System (PQRS) and Electronic Prescribing (E-RX) government incentive program reporting, along with a brief review and commentary on the practice’s operations in connection with HIPAA Privacy and Security requirements.

Prices for each level are set by the number of providers included in the review. For further information and to request a proposal for services, email pracman@AUAnet.org.

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