Specifications include, but are not limited to: Auditing Services. Contractor will perform retrospective and routine coding compliance audits of District providers at a pre-determined percentage of accounts as agreed between the parties . Contractor will audit entire medical records including the provider progress notes, physician orders, ancillary reports, operative/procedure reports, medication administration records, the coding summaries and/or UB04s. Contractor will determine the accuracy and integrity of coding in accordance with ICD-10-CM/PCS Guidelines for Coding and Reporting, CPT Guidelines, AHA Coding Clinic, CPT Assistant, current Centers for Medicare and Medicaid rules and regulations, as well as facility-specific coding and abstracting guidelines and policies. If a difference exists between the District’s originally reported evaluation and management (E/M) level and the Contractor’s level, Contractor will provide a brief description of the rationale for the E/M leveling difference. If the District’s original level and the Contractor’s level are the same, no explanation is necessary. All documentation will be reviewed for medical necessity of all services and procedures performed. Audit findings will be documented on a standard audit spreadsheet and will include an executive summary report at the conclusion of reconciling any and all rebuttals made by the District. Contractor guarantees that all assigned auditors hold one or more medical coding credentials from AHIMA and/or AAPC. Contractor will conduct routine audits of its own auditors, at no additional cost to the District, to guarantee an accuracy rate standard of 95% or higher. Upon request, Contractor will provide accuracy reports on all assigned auditors on a monthly basis. Physician & Coder Education Contractor will provide virtual and/or in-person exit audits on a monthly or quarterly basis, or as required by the District, to its providers (including contracted provider groups) and coders. These exit audit education sessions will address error trends with financial impact, improper documentation and coding practices, and other areas of concern discovered and identified through Contractor’s retroactive and routine audits. Consultation. Consultant will provide guidance to the District and its providers (including contracted provider groups) on specific coding related inquiries, review and/or develop educational materials, and deliver education to targeted individuals as requested.
