The scope of a medical chart audit is verifying that charges on the detailed itemized hospital bill are accurate and that charges represent services rendered to the patient, ordered by the physician and are based upon standard hospital practices.
Nurse Auditing Service
We provide a staff of experienced Nurse Auditors, which include: Nurse Practitioners, Masters Prepared Registered Nurses and Certified Medical Audit Specialist (CMAS) with strong clinical and billing experience.
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Our Nurse Auditors will review the complete medical record. This 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 billed.
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Third Party Defense Audits
These are audit performed by a third party on behalf of a specific payer(s). The scope of these audits are to verify charges on the detailed claim are accurate, represent services rendered to the patient, and are ordered by a Physician. However, services and items may be provided based upon standard hospital practices and/or medical/clinical protocols and procedures.
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AHAP Nurse Auditor will serve as the primary liaison between the hospital and any outside audit party on audits requested or disputed by a third-party audit company representative on behalf of an insurance carrier.
Monthly Audit Statistic Report
AHAP services includes precise audit details providing audit outcomes detailed by a monthly audit statistic report to identify departments showing a trend of over charges and under charges including departmental error rates. These audit statistic reports 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 to achieve your Medical Chart Auditing goals. We tailor a comprehensive audit program designed to meet your individual needs.
Focus/Business Office Request Audits
Focus and Business Office Request Audits are single or multiple account audits from various individuals or departments within the facility. These account audit requests originated from, but not limited to, Clinical Departments, PFS, HIM and Finance taking an in-depth look at small segments of hospital’s charging structure to make a determination, decision, or conclusion about specific billing or charging practice.