Vital Signs Blog

Dermatology Coding Audit

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SUMMARY

Medic Management Group provides coding audit services for physicians of all specialties. Our services start with baseline audits and include group or one-on-one training with practice physicians and staff. Through detailed chart reviews and due diligence, our professionals can identify inefficiencies and make recommendations for improvements to coding and documentation.

Providers who enact Medic Management Group recommendations and agree to regular monitoring (every six months or annually) typically improve their accuracy scores by 5-20 percent. A 95 percent accuracy rate is suggested to establish confidence.

We currently recommend that providers review diagnosis codes to ensure that the documentation in the record deems them appropriate. This gives providers a head start on preparing for ICD-10.


CLIENT BACKGROUND

A dermatology practice based in Northeast Ohio requested Medic Management Group to perform a coding audit. The practice, in business since 1949, currently has seven physicians offering services including laser surgery, laser hair removal, and Mohs surgery, with a dermatopathologist on staff. In 2011, the practice saw 25,350 patients. Charges were about $9 million, with collections totaling more than $5.4 million.


CHALLENGE

The dermatology practice asked Medic Management Group professionals to evaluate its providers to determine if the level of service billed was appropriate, based on data from its medical records. The physicians were happy with a previous chart audit performed by MMG and chose our professionals to perform the audit. The audit was performed to ensure they were on track with billing, to avoid refunds, and to show their due diligence with maintaining compliance.

 

APPROACH / SOLUTION

A baseline audit consisting of 10 records was performed on an individual provider within the dermatology practice. This approach determined whether ongoing monitoring would be warranted, based on a percentage of accuracy.

The sample was chosen from the practice utilization billing reports of evaluation and management codes from the past six to 12 months. Using the report information, Medic Management Group entered data into the national bell curve by specialty to determine the provider's risk and chose the over usage of codes to review.

With both reviews in this case, Medic Management Group was asked to focus on office evaluation and management codes. (When performing chart reviews, other areas addressed may include possible missing revenue, proper modifier usage of modifiers, and RVU order, if applicable.)


RESULTS

The first chart review was done in June 2010. Medic Management Group discovered the following:

  • Based on legibility and levels of service the documentation substantiated, a lower level of service was provided than charged.
  • The provider's accuracy rate was 60 percent.

Medic Management Group professionals conducted an education session with the provider that included an overview of issues, a review of materials that supported the study's findings, and recommendations to resolve them.

A follow-up chart review of the same provider was performed in March 2012 using the same method. His accuracy rate increased by 20 percent, reducing refund liabilities by more than 50 percent - a net decrease in total RAC audit liabilities of nearly $36,000 per year.

“The support from MMG helped us create a group that functioned as a cohesive business unit with many separate locations.”

— Kenyokee Crowell, Administrator, Regional Practices
Cleveland Clinic Health System