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Medical Coding Audit Profile - GetixHealth
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Medical Coding Audit Profile

Comprehensive Coding Profile & Data Analysis

GetixHealth routinely provides coding profile and data analysis for clients to initiate valuation of a practice and develop a meaningful audit sample that can offer trends, analysis, and a starting point for the coding audit.

 

Using comparative data from Medicare along with review of individual physician data, the profile and analysis provides an opportunity for the practice to identify introspectively its practice patterns and risks within the practice.

data-analysis

Medical Coding Profile

GetixHealth obtains key data elements from the practice to develop an inventory of procedure and/or evaluation and management (E&M) visit counts across the practice.

 

These are quantified individually and as a group to ensure a complete understanding of the practice.

  • This creates a viable sample of the practice from which actual records can be pulled.
  • This forms a preliminary illustration of practitioner patterns and outliers.
  • This provides a meaningful sample to address potential risk areas.

GetixHealth uses in-depth comparative data to identify practice patterns and risks...

In-Depth Data Analysis

GetixHealth compares the group and providers’ profile with indicators from Medicare utilization data, local and national coverage determinations, and auditing risk areas such as the Office of Inspector. This is determined on a specialty basis to evaluate if profile patterns significantly deviate from national practice norms or pose risks to the group. GetixHealth also evaluates procedures for inconsistencies with coding guidelines and the presence of coding anomalies.

  • GetixHealth identifies coding risks based on deviations in E&M and procedural data presentation that may influence the practice.
  • E&M benchmarks come from Berenson Eggers Type of Service (BETOS) Medicare national utilization data by specialty.
  • These risk areas could signify audit targets across government and commercial payers.
  • GetixHealth identifies practitioners who are significantly differing from the performance of others in the group.
  • GetixHealth considers procedure and E&M volume and variations that may affect risk.
  • GetixHealth recognizes patterns that may suggest further issues with documentation, understanding of codes, and missing charges.

Audit Selection

GetixHealth compiles information from the coding profile and data analysis to develop a meaningful
audit selection that is addressing potential areas of risk for the practice.
  • Samples

    The Client is not burdened with developing an audit sample.

  • Risk Identification

    The audit sample addresses potential risks from an evidence based perspective rather than a random selection that may miss areas of concern.

  • Validation

    The audit sample can focus on specific areas to validate or explore further to confirm or refute profile hypothesis.

  • Revenue Discovery

    The audit sample covers relevant services that should be confirmed to ensure that a practice is valued correctly. Where documentation differs from the codes billed, there may be a different in revenue for the practice.

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