File Review and Case Review

There are 7 elements to a payable claim and each element is equally necessary to ensure a sound patient record and clean claim submission. Compliance guidelines also require that healthcare organizations peridocially assess patient records and billing data to ensure that all applicable guidelines are being properly adhered to.  For some practices, a periodic review may be once per year.  For others, this may be a quarterly or semi-annual process to ensure that errors are corrected and other necessary changes and improvements are properly implemented.

What is a File Review and Why is it Necessary

The File Review consists of a detailed evaluation of selected patient records including the following documents: 

New patient exams                         CPT/HCPCS code selection                              Fees

Re-exams                                          ICD-9/ICD-10 diagnosis code selection          Insurance/patient billing and collections

Daily treatment notes                     Modifier use                                                         Required forms (ex. ABN)

This information will be comprehensively evaluated to ensure compliance with documentation and billing guidelines, and other applicable protocols.  A detailed Report-of-Findings is prepared and reviewed in detail with the provider(s) and applicable workforce members to discuss all File Review findings and establish an action plan for improvement.

Even the most structured and well-trained healthcare organizations must take steps to continue to minimize risk.  A proactive approach is always more beneficial to the health of any business system. As such, a regular file review is an essential part of conducting business, not to mention, a necessity to demonstrate ongoing efforts to maintain compliance.

Importantly, healthcare organizations often add new providers and/or new employees that are responsible for documentation, data entry, billing, and collections.  When adding someone new to your team, although adequate training may have been conducted, it is a frequent occurrence to find errors, oversight, or inconsistency, which leads healthcare organizations and providers into vulnerable territory.  This can not only affect cash flow but will also increase the risk of an external audit.

Questions About File Reviews

The CCS team of compliance and auditing specialists will work with you to find and fix errors before payors do.  We will also assist you in developing a strategy for improvement and risk management. This provides a significant measure of protection for practices and reduces your risk of stressful and costly 3rd party audits and recoupment efforts.  When working with a CCS specialist to conduct a File Review, you will be provided a specific checklist of documents which includes the number of patient files that will need to be provided to your CCS consultant.  The File Review fee is $599 for 7 files.

For questions or to work with a CCS specialist, contact us by submitting your inquiry to our Help Desk.

What is A Case Review

The increase of audits and reviews by payors is of great concern to practices.  And it should be!  Practices are frequently receiving refund requests from payors that they weren't even aware was investigating claims.  Practice are also receiving notices of audit and record requests, where pages of supporting information is required to be sent in for review.  There are various types of audits and it is impossible for practices to know exactly how to handle each scenario.  Chiropractic Compliance Solutions provides the expertise of trained and credentialed professionals to evaluate your audit scenario.  In a one hour evaluation, our professionals will be able to identify the best approach for resolution for your practice.  This provides necessary guidance for practices when taking the next step to address the audit or refund request.  

Guidance often includes specific action steps for the practice, guidance and tips for efficient handling, recommendations for future prevention, and even attorney recommendations if necessary. Upon scheduling your Case Review, you will be provided with a HIPAA secure portal to transmit data to your Chiropractic Compliance Solutions consultant.  Don't make the mistake of waiting to see what happens and don't lose money unnecessarily, by seeking the help of CCS expertise.  

The Chiropractic Compliance Solutions Case Review is a $299 charge for a one hour audit evaluation.  If you have questions, please connect with us live online from our home page or submit an inquiry to our HelpDesk.  Our team will reach out to you promptly.