One of the big challenges in acquiring physician practices or hospitals merging their physician enterprise is the diligence and ongoing monitoring of physician coding practices. Most organizations will do a sampling of physician coding practices, which leaves a high percentage of physician’s practices that are not fully assessed. Obviously, this can result in significant compliance exposure for over coding or under coding and result in revenue loss when a physician is under coding due to poor documentation. The manual process of auditing physician coding practice results in greater risk for the acquiring physician practices, the merging of hospitals which employ physicians, the PE investment in physician practices and the overall monitoring of coding practices.

This is a great audit tool to quickly assess all employed physician coding practices and determine where there may be over coding (risk exposure) or under coding (revenue opportunity). Most organizations conduct random coding audits, but his can take years to complete and potentially allow risk exposures to continue for months.

Empowered by sophisticated analytics, Artificial Intelligence and an amazing visual display, this solution proactively identifies coding risks mitigating unnecessary risk exposure from HHS, CMS, MAC, RAC, FBI, and insurance audit penalties; AND identifies unrealized revenue opportunities at the same time. It offers a secure subscription service that analyzes all billing data, “revealing” in minutes which providers are compliance risks so appropriate focus, intervention and education can be initiated BEFORE an external audit is triggered.

With over 50 risk indicators crafted from the industry’s leading experts and audit entities, the solution goes far beyond generic utilization comparisons; which performs sophisticated outlier testing. As a result, an organization will know exactly who is at risk and why – not relying on “random discovery”! It is the smartest, simplest way to analyze prospective and current physicians’ practices.

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