Specifications include, but are not limited to: Comprehensive, retroactive review of medical and clinical staff documentation, coding, and billing practices. Contractor shall provide all labor and materials to provide a comprehensive off-site review of 800 out-patient and 40 in-patient/observation visits per quarter for Cherokee Nation Health Services. The review will focus on professional and facility charges for both out-patient and inpatient/observation visits, when applicable. The areas of review include, but are not limited to the following: Inpatient Services – Med Surg, Labor and Delivery, ICU, Observations, Surgery and Anesthesia ; Outpatient Services – Family Medicine, Same Day Clinic, Orthopedic, Podiatry, Infectious Disease, OB/GYN, Emergency Department, General Surgery, Ancillary, Cardiology, Physical Therapy, Occupational Therapy, Audiology, Radiology, Laboratory, Ambulatory Day Surgery, Pediatrics, Urgent Care, Behavioral Health, Public Health Nursing, Dietary, and Respiratory Therapy. The medical and clinical staff documentation review shall identify documentation weaknesses, including but not limited to (1) diagnosis does not support the procedure, (2) insufficient provider documentation to support medical necessity, (3) procedure documentation, and (4) all other documentation insufficiencies identified. The outpatient coding review shall identify diagnosis and procedure coding variances, including but not limited to (1) accurate selection of ICD-10-CM, CPT, and HCPCS codes, (2) code sequencing, (3) modifier use, and (4) an explanation of coding logic. The inpatient coding review shall identify diagnosis and procedure coding variances, including but not limited to (1) a DRG audit, (2) accurate POA indicator, (3) accurate selection of ICD-10-CM, CPT/PCS, HCPCS codes, (3) code sequencing, (3) modifier use, and (4) an explanation of coding logic...