In the dynamic landscape of healthcare, precision and compliance are paramount. At Revnucare, we stand as your trusted partner, bridging the gap between meticulous medical auditing and optimized revenue cycles. Our CPMA-certified experts bring unparalleled proficiency across diverse specialties, ensuring that every medical record is scrutinized with precision. But what sets us apart? Let’s explore.
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Precision Unleashed: Our auditors possess an intricate understanding of coding guidelines, documentation requirements, and reimbursement intricacies. We dissect medical records with a surgeon’s precision, identifying gaps, inconsistencies, and potential risks.
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Revenue Leak Prevention: Revenue leakage—often subtle, yet impactful—can erode financial stability. Revnucare’s audits act as a vigilant shield, plugging revenue leaks by validating coding accuracy, ensuring proper charge capture, and minimizing denials.
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Compliance Assurance: Compliance isn’t a mere checkbox; it’s the bedrock of sustainable healthcare practices. Our audits align your documentation with regulatory standards, safeguarding against penalties and legal pitfalls.
Impactful Outcomes:
- Improved revenue cycle efficiency
- Enhanced clinical documentation
- Reduced audit vulnerabilities
- Strengthened compliance posture
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Tailored Approach: We recognize that each specialty demands unique scrutiny. Our auditors specialize in specific fields, ensuring context-aware reviews that resonate with your practice.
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Prospective and Retrospective Audits:
- Prospective audits prevent errors before claims submission.
- Retrospective audits retrospectively validate coding accuracy and compliance.
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Risk Adjustment Excellence:
- Our HCC audits align documentation with diagnosis coding, optimizing risk scores.
- Approximately 95% of charts reviewed reveal undocumented chronic conditions, positively impacting reimbursement.
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Documentation Improvement:
- We collaborate with providers, enhancing DRG accuracy, capturing overlooked CC/MCCs, and promoting comprehensive queries.
- Clinical outcomes improve, and financial health thrives.
At Revnucare, we don’t just audit; we elevate healthcare integrity. Let our expertise fortify your compliance program, ensuring accuracy, profitability, and peace of mind.
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E/M services are the backbone of healthcare encounters.
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Our auditors meticulously review documentation, ensuring proper E/M code selection.
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We validate medical necessity, level of complexity, and adherence to guidelines.
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Surgery codes span a wide spectrum—from minor procedures to complex surgeries.
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Revnucare’s experts scrutinize surgical documentation, ensuring precise coding.
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We verify procedure details, modifiers, and global periods.
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Pathology services involve intricate coding for biopsies, cytology, and molecular testing.
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Our auditors validate accurate CPT and HCPCS codes.
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We ensure alignment with pathology reports and clinical findings.
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Gastroenterology procedures—endoscopies, colonoscopies, ERCPs—are critical.
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Revnucare’s audits focus on proper coding, bundling/unbundling, and medical necessity.
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We safeguard against missed charges and compliance pitfalls.
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Collaboration with providers is key.
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We bridge gaps, capture overlooked diagnoses, and promote comprehensive queries.
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Improved documentation leads to better outcomes and financial health.
Setting: A bustling operating room, where precision meets urgency. Dr. Rodriguez, a skilled orthopedic surgeon, recently performed a complex knee arthroscopy. The patient, a soccer enthusiast, had torn their meniscus during a spirited match. Dr. Rodriguez meticulously documented the procedure, capturing every detail—the incisions, the scope’s movements, and the delicate sutures.
Enter Revnucare’s auditor, Sarah. Armed with her CPMA certification and a keen eye, she reviews the surgical notes. Here’s what unfolds:
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Code Verification:
- Sarah cross-references Dr. Rodriguez’s notes with the CPT code billed.
- She ensures that the code accurately reflects the complexity of the procedure—a balance between precision and efficiency.
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Modifier Scrutiny:
- Dr. Rodriguez used a specialized scope (modifier -22) due to the challenging anatomy.
- Sarah validates the modifier, ensuring it justifies the additional work involved.
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Global Period Check:
- Knee arthroscopy falls under a global surgical package.
- Sarah verifies that any related post-operative visits are appropriately bundled.
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Medical Necessity Assessment:
- Why did Dr. Rodriguez choose arthroscopy over other options?
- Sarah digs into the clinical context, ensuring medical necessity aligns with the chosen procedure.
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Documentation Clarity:
- Sarah leaves no stone unturned. She seeks clarity on the surgical approach, instruments used, and any unexpected findings.
- Her goal? Accurate coding and optimal reimbursement.
The outcome? Dr. Rodriguez’s meticulous documentation pays off. The correct CPT code, supported by comprehensive notes, ensures fair reimbursement. The patient’s knee heals, and the soccer field awaits their triumphant return.
Setting: Dr. Patel’s bustling clinic, where patients flow in like a steady stream. Dr. Patel, a seasoned internist, spends her days juggling patient visits. Today, she encounters Mrs. Lawson, a retiree with multiple chronic conditions. Dr. Patel’s E/M services are her lifeline—a delicate balance of empathy, assessment, and decision-making.
Revnucare’s auditor, Mark, steps into Dr. Patel’s shoes (figuratively). Here’s how he conducts the E/M audit:
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Level Selection:
- Mark reviews Mrs. Lawson’s chart. Was it a straightforward visit (99212) or a more complex encounter (99214)?
- He assesses the history, examination, and medical decision-making components.
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Medical Decision-Making (MDM):
- Mrs. Lawson’s hypertension, diabetes, and osteoarthritis demand attention.
- Mark evaluates Dr. Patel’s MDM—weighing risks, considering lab results, and adjusting medications.
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Time Consideration:
- Dr. Patel spent 25 minutes with Mrs. Lawson.
- Mark ensures that the E/M level aligns with the documented time.
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Supporting Documentation:
- Mark looks for evidence of chronic condition management, preventive care discussions, and shared decision-making.
- He seeks clarity in Dr. Patel’s notes.
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Coding Accuracy:
- Mark confirms that Dr. Patel coded the visit correctly.
- He appreciates thorough documentation—it’s the compass guiding reimbursement.
The result? Dr. Patel’s E/M services receive a nod of approval. Mrs. Lawson leaves with renewed prescriptions, a care plan, and trust in her physician. Mark? He smiles, knowing that precision in E/M coding ensures quality care and financial stability.
