Outpatient Auditing & Compliance
With the increasing shift of services to the outpatient setting, the need for outpatient auditing and compliance is becoming more and more critical to ensure accuracy, quality, and compliance in this environment.
Panacea applies the same proven, unique approach to outpatient reviews as we use on the inpatient side, focusing on surgery, infusion and chemotherapy, as well as emergency department and other ancillary services (CPT, E&M, diagnosis, and facility and professional components).
Our expert consultants work closely with you to determine the correct methodology for your organization, conducting a comprehensive review:
- Evaluating your team’s skills in ICD-10-CM and CPT®
- Analyzing your claims information to target specific areas for focused audits
- Assessing the appropriateness of ICD-10-CM diagnosis and HCPCS/CPT procedure code selection, facility evaluation and management (E&M), modifiers, and completeness of documentation to support accurate code assignment
- Validating physician orders, LCDs, and NCDs for medical necessity of services
- Ensuring correct code transfer to the claim forms and proper APC payment received on the remittance advice
- Identify and minimize risk areas
- Ensure accurate code assignment for improved reimbursement