| Since 1996, PPS has conducted our services with
a compliance oriented approach backed by a clinically based procedure code auditing
system. Our experience with compliance officers and law firms has enabled us to
design the following services.
The following are examples
of topics that have been reviewed:
- Correct coding of the level of care or the procedure being performed
- Correct usage of modifiers
- Correct billing of supplies and ancillary services
- Self-disclosure Random Sample audits to determine overpayment amounts in the
areas of physician and hospital billing for Medicaid and Medicare
- Payor negotiations
- Correct application of APCs
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- Incorrect usage of “Incident To” with mid levels, NPs and PACs,
resulting in overpayments for not following the guidelines
- Documentation standards not being met or documentation for teaching physicians
not being met. This can impact reimbursement and result in the return of funds
already paid by the carrier.
- Improper use of E & M codes with injections
- Correct physician UPIN billing
- Inpatient evaluation and management coding
- Self-reporting violations of Medicare compliance
- Reporting coding audits, and designing ongoing compliance programs
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