Charge Review – The Secret to Cleaner Claims

Chances are many of you reading this do not have certified coders reviewing physician encounters.  Those of you who do work with certified coders likely only have a percentage of physician encounters passing before their trained eyes. Are you relying on the physician to code? Why only a percentage of encounters and not all encounters? Some have great EMRs with programming capabilities that eliminate the need for human review of every piece of an encounter. However, even if the programming you have in place cuts down on the work coders need to do, shouldn’t they still be looking at most encounters before they are translated to a claim form?

speroMD conducts 100% charge review. We certainly try to put the EMR to work for us when we can program a rule that will eliminate some of this review, but the reason why our coders are so valuable is that their work product is one that requires human review, and it is not wholly programmable.

Full charge review conducted by certified coders results in cleaner, more accurate claims. Coders review the documentation to ensure full charge capture and, if an evaluation and management service is involved, to ensure that the appropriate level of service was chosen. Even though there are plenty of physicians who are strong coders, most are probably not experts with regard to modifiers. This is another reason we conduct full charge review – to ensure the appropriate modifiers have been added and any superfluous modifiers have been removed. This volume of charge review results in fewer denials, better charge capture, and is an effective way of maximizing your reimbursement potential.