Encounter # Date Code Description
Diagnose
Code
Diagnose Code Description Charge
5556 10-06-19
99214
99213
Office Visit M67.40 Ganglion Of Joint
$193.00
$130.00
5171 10-14-19
99214
99213
Office Visit I10 Hypertension Nos
$193.00
$130.00
3255 10-27-19
99214
99213
Office Visit R51 Headache
$193.00
$130.00
4884 11-03-19
99214
99213
Office Visit I10 Hypertension Nos
$193.00
$130.00
6666 12-08-19
99214
99213
Office Visit I10 Hypertension Nos
$193.00
$130.00
502 12-10-19
99214
99213
Office Visit J20.9 Acute Bronchitis
$193.00
$130.00
6998 12-30-19
99214
99212
Office Visit R06.02 Shortness Of Breath
$193.00
$78.00
4612 10-06-19
99214
99212
Office Visit I10 Hypertension Nos
$193.00
$78.00
2426 10-15-19
99214
99213
Office Visit E11.65
Dm Uncomp Type II
Uncntrd
$193.00
$130.00
Incorrectly billed $1,737.00
Correct total $1,066.00
Overbilled $671.00
Family Practice Claims for Audit Results 2019
As a part of the coding compliance process of Southern New Hampshire University, an annual audit was conducted on the Family
Practice Charges Claims in the year 2019. The audit of the charts of the providers was completed. A chart was prepared with t
of the past 90 days encounters for each of the providers. In order to choose ten random charts for each provider, the charts
evaluation and management codes for the office visits of established and new patients were used. Next, the medical documentat
present in these charts was printed or copied and sent to the auditor for proper evaluation. A number of exceptions were foun
the process of audit. All these exceptions were listed down in the spreadsheet. The charts that didn’t match the required
documentation level for the specific codes billed have been mentioned in this summary. A total of 150 charts were evaluated.
them, nine charts were found not to have met the essential documentation level for codes billed. All the over
use of evaluation and management code 99214. Seven of the charts supported the evaluation and management code 99213. On the
them, nine charts were found not to have met the essential documentation level for codes billed. All the over
use of evaluation and management code 99214. Seven of the charts supported the evaluation and management code 99213. On the
other hand, two charts supported evaluation and management code 99212. The payers were provided with an incorrect bill that
amounted to $1,737.00, while the actual bill should have been $1,066.00. A measure that can be implemented by the Family Prac
providers in order to avoid such errors is to carefully check that the documentation entered into the medical records matches
level of services that the payers have been billed with. It is also important to have a billing specialist who has in
the area. The billing specialist can review the documentation of the provider and ensure that the documentation has used the
code that was actually selected for billing the payer.
Payer Provider #
Identified Errors
in
Documentation
Blue Cross
Blue
Shield
1
Overcoded:
Elements
support 99213
Medicare
Part B
2
Overcoded:
Elements
support 99213
Blue Cross
Blue
Shield
4
Overcoded:
Elements
support 99213
Medicare
Part B
5
Overcoded:
Elements
support 99213
Humana 9
Overcoded:
Elements
support 99213
Aetna 10
Overcoded:
Elements
support 99213
Medicare
Part B
12
Overcoded:
Elements
support 99212
Blue Cross
Blue
Shield
13
Overcoded:
Elements
support 99212
Blue Cross
Blue
Shield
15
Overcoded:
Elements
support 99213
Family Practice Claims for Audit Results 2019
As a part of the coding compliance process of Southern New Hampshire University, an annual audit was conducted on the Family
Practice Charges Claims in the year 2019. The audit of the charts of the providers was completed. A chart was prepared with the use
of the past 90 days encounters for each of the providers. In order to choose ten random charts for each provider, the charts with
evaluation and management codes for the office visits of established and new patients were used. Next, the medical documentation
present in these charts was printed or copied and sent to the auditor for proper evaluation. A number of exceptions were found in
the process of audit. All these exceptions were listed down in the spreadsheet. The charts that didn’t match the required
documentation level for the specific codes billed have been mentioned in this summary. A total of 150 charts were evaluated. Out of
them, nine charts were found not to have met the essential documentation level for codes billed. All the over-coded charts had m
ade
use of evaluation and management code 99214. Seven of the charts supported the evaluation and management code 99213. On the
them, nine charts were found not to have met the essential documentation level for codes billed. All the over-coded charts had m
ade
use of evaluation and management code 99214. Seven of the charts supported the evaluation and management code 99213. On the
other hand, two charts supported evaluation and management code 99212. The payers were provided with an incorrect bill that
amounted to $1,737.00, while the actual bill should have been $1,066.00. A measure that can be implemented by the Family Practic
e
providers in order to avoid such errors is to carefully check that the documentation entered into the medical records matches the
level of services that the payers have been billed with. It is also important to have a billing specialist who has in-depth knowledge in
the area. The billing specialist can review the documentation of the provider and ensure that the documentation has used the right
