The scope of a medical audit is verifying that charges on the detailed itemized hospital bill are accurate and that charges represent services rendered to the patient and are ordered by physician and are based upon standard hospital practices and/or nursing protocols and procedures.
We provide a staff of experienced Nurse Auditors, which includes: Nurse Practitioners, Master Prepared Registered Nurses and Certified Medical Audit Specialist (CMAS) with strong clinical and billing experience.
Our Nurse Auditors will review the complete medical record, which includes doctor’s orders, nurse’s notes and various department reports line-by-line against the itemized bill to ensure that all ancillary services, surgical procedures, supplies, medications, etc. were ordered & delivered to the patient as charged.
AHAP services include not only precise audit details providing audit outcomes but also a detailed monthly audit statistic report to identify departments showing a trend of over charges and under charges including departmental error rates. These audit statistic reports, help to identify the reasons why the over and under charges are occurring and can further assist departments in creating a corrective action plan for resolution to prevent errors from reoccurring. Our role and objective is to form an alliance with your organization in order to assist you achieve your Medical Chart Auditing goals. We tailor a comprehensive audit program designed to meet your individual needs.
“Making a difference where it counts!”
"There are many steps that inpatient hospital providers can take to avoid denial of their claims when submitting Medicare fee-for- service claims. The Centers for Medicare & Medicaid Services (CMS) discussed numerous findings uncovered by Recovery Audit Contractors during a March 9, 2011 podcast. To prevent future improper payment issues, CMS encouraged providers to understand the "lessons learned" listed below, take necessary steps to meet Medicare documentation requirements, and implement corrective actions." Read on