Clinical & Billing Record Audits, Appeals & Consultation

Providing On-Sight & Off-Sight Services (Electronic or Paper)

Our Goals for Performing Audits Are:

    • To assist our clients identify documentation, coding and billing strengths and weaknesses
    • To provide authentic and trusted resources to support findings
    • To prepare our clients with tools and the aptitude to perform internal audits
    • To provide regulators auditing our clients with evidence of pro-active compliance behavior

BCMS, Inc. offers both On-Site and Off-Site Clinical & Billing Record audits. At this point both physical therapy and occupational therapy records are reviewed by physical therapists with extensive experience in chart auditing and corrective action intervention.

The advantage of an On-Site Audit is that there is less administrative preparation required of the staff as the charts are chosen by the on-site surveyor and then additional documents are drawn based on need. Face to face consultation occurs during the site visit which provides for immediate feedback.

The advantage of an Off-Site Audit is pricing. There are no travel related costs for off-site audits, but the administrative time to prepare charts cannot be overlooked as an expense. If the audit is performed via secure web access the administrative burden is, again, reduced as the selection process is much like an On-Site Audit. Teleconferences are set up to discuss the audit report and any action plan needed.

Typically, three charts are selected for each .50 FTE licensed professional; however in some cases we perform pilot audits to determine whether different parameters need to be considered. There are specific timeframes and episode lengths specified for each chart audited to assure compliance with regulations, standards and guidances.

Once we have completed an audit and rendered a report we provide support documents and resources to validate our review as well as to provide corrective action tools. We also provide ‘train-the-trainer’ sessions so that our clients can become proficient in performing internal audits.

Pre and Post Payment Appeals and Audit Consultation Interventions:

1. Assess the facts and required action
2. Establish an action plan and calendar
3. Identify the responsible parties
4. Collect, organize and audit applicable clinical & billing records
5. Prepare and submit the written appeal including support documents
6. Evaluate the appeal outcome
7. Make recommendations for outcome response, if applicable
8. Take the appeal to the next level if applicable

For more information please contact: Mary Daulong at (281) 866-9505 or daulongm@earthlink.net