SMARTCompliance
Designed to educate, evaluate, deliver and develop
  • Is your practice at risk for a Medicare or other payer audit?
  • Are you leaving money on the table?
  • Are you maximizing revenue by capturing all “codeable events”

Our Peace of Mind Guarantee!RT Welter’s SMARTCompliance program offers a Peace of Mind Guarantee for providers and practices. Our program will act as the first line of defense in the event of a payer audit, identify potential savings, identify missed and new opportunities to increase revenue, reveal your risk level for an audit, educate your providers, as well as demonstrate your organization’s emphasis on compliance. We strive to create a partnership with your organization so that in the face of payer audits, recoupments, reduced payments, and all of the many changes and challenges in healthcare reimbursement, you are prepared to not only sustain but thrive.

In FY 2013, CMS RAC auditors identified and corrected $3.75 billion in improper payments. There were $3.65 billion collected in overpayments and $102 million in identified underpayments paid back to providers. If you have received a CMS RAC audit letter or commercial payer audit request, call us! We can help!

By identifying only one coding error, each of your providers can produce (or save if there is risk of a take back) about $20,000 in additional revenue – that’s our Peace of Mind Guarantee!

The Financial Impact of Missing Documentation

If all office visits are coded and billed as 99213 “to be safe”… The reimbursement difference between 99213 and 99214 (Medicare) is $35.00...

If this documentation and coding error occurred with 50 patient visits per month (should have billed 99214), the total over one year, for one provider, is $21,000.00 in lost revenue!

SMARTCompliance Program Overview

General coding and documentation session to introduce providers to the Evaluation and Management documentation guidelines as a prelude to the evaluation. This training will be specialty specific. For example, neurologists would need different education than primary care physicians. We recommend this training be done in a group session.

We will dig deeper to identify your provider’s documentation discrepancies with an evaluation of their documentation. We will look at the provider’s documentation as if a RAC auditor would and highlight areas that need improvement. Over-coding, under-coding, and documentation discrepancies are just a few of the things we review. The evaluation results will include a cost-breakdown of over-coding and under-coding encounters. This information will identify how much money you are potentially leaving on the table (i.e. missed revenue) or potential risk your providers and practice face because of revenue collected in error as a result of over-charging the payers. Various options include:

  • Evaluation and Management (E&M) Audit of 20 notes per provider
  • Evaluation and Management Audit of 20 notes per provider with minor office procedures
  • Evaluation and Management Audit of 20 notes per provider with Medicare Annual Wellness Services
  • Evaluation and Management and Surgical Audit of 20 notes per provider (20 E/M and 10 major operative procedures)
  • Surgical Procedure Audit of 20 notes per provider

We will deliver the evaluation results via one-on-one education with each provider or small groups of 3, regarding the coding and documentation deficiencies identified in the evaluation, areas with potential for increased revenue, reinforcement of the information covered in the initial group training session, and Q&A with any coding/documentation questions.

We will help you develop an Internal Compliance Program for your organization to carry on coding compliance for the long term protection of your providers and practice. In today’s health care marketplace, recent laws and regulations illustrate the government’s focus on scrutinizing the actions of hospitals, physician practices, and other healthcare providers. You need to protect yourself from potential civil and criminal sanctions. Having a compliance program is the way to ensure this protection. The Department of Health and Human Services, the Office of the Inspector General, and CMS encourage health care organizations to establish and implement compliance programs as a way to demonstrate your efforts to comply with state and federal laws. In some cases, federal law even mandates providers to have an effective compliance program. Our knowledgeable experts will customize a compliance program based on an assessment of your needs. Whether you are starting from the ground up or already have a compliance structure in place, our goal is to help prepare and protect you in today’s challenging healthcare environment.

Additional Coding Services

Outsourced Coding Assistance
Finding qualified and experienced coders can be challenging! Our remote coding services serve as an extension of the practice and can be used for coding backlogs, coverage for an employee absence, etc. We provide coding services for all medical specialties, for small and large group practices and hospitals, including CPT, ICD-10, HCPCS, surgical/operative note coding, etc.

Billing Review
We will review HCFAs in conjunction with documentation to determine if billing was appropriate. We will look for opportunities to maximize revenue as well as point out any billing and coding errors that may be occurring.

Bell Curve Analysis
We will review productivity reports and compare data to the national Medicare averages. The analysis will show a distribution of evaluation and management codes for the year compared to national Medicare averages by specialty. This analysis will help identify outliers by specialty and reveal your risk for an audit, identify correct coding, billing, and revenue maximization.