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Chart Audits



Medical Chart Audits


Typically, we will review from 3 to 30 charts per practitioner. The charts will be reviewed by our certified coding and health information experts for the following:

  1. Compliance with Centers for Medicare and Medicaid Services (CMS) and specialty documentation guidelines.

  2. Comparison to hospital records (if available).

  3. Clinical abstracting and data collection methods Correct ICD-9 and CPT coding.

  4. Compliance with Centers for Medicare and Medicaid Services (CMS) National Correct Coding Policy System for capturing charge data.

Most chart audits can be done remotely. We prefer an equal number at:

30 days Date of Service
60 days Date of Service
90 days Date of Service

Each audit should contain the:

  1. Doctor's notes

  2. CMS 1500 Form

  3. Fee Ticket

  4. EOB's if available.

Our certified coders will provide an in-depth analysis of coding and billing techniques to identify deficiencies and potential opportunities for future revenue enhancement. A complete report will be provided with specific analysis of each encounter reviewed.

¨    Unspecific ICD-9 Codes

¨    Codes not age appropriate

¨   Coding for deep tissue repair.

¨    Unbundled Codes”

¨    E Code Usage

¨   Level 4 & 5 Visits

¨   Upcoding

¨   Downcoding

¨    V Code Usage

¨    Modifier – 50

¨   Modifier – 52

¨    Inappropriate Codes

¨    Modifier – 26

¨    Modifier – 51

¨   Modifier – 90

¨    Modifier - 25

¨    Improper use of “After Hours” codes

¨   Improper use of consultation E & M codes.

¨   Incorrect units of service for injections

¨    Injection Administration Codes

¨   Correct Use of HCPCS codes

¨     ICD-9 & CPT linking

¨    Documentation Errors

¨    Documentation Omissions

¨    Missing EKG  report

¨   Proper coding for supplies

¨    Late Effects      coding

¨    Medical Decision Making

¨    Lack of appropriate History


¨    Nature of Presenting Problem



We review the claims for timeliness, completeness and enclosure of appropriate attachments when necessary. We will evaluate the procedures for follow-up of unpaid claims and resubmission of denied and rejected claims. We review invoices from labs and medical supply companies in order to determine if these charges are being captured properly. The desired result is reduced claim rejections and denials, more "clean claims," improved cash flow, and appropriate reimbursement.

As part of our evaluation process, we will review the current superbill/charge ticket being used in each clinic and will analyze the procedures for collecting and verifying patient personal and insurance data and make specific recommendations as necessary.

At the conclusion of our review, we will hold an exit conference with the physicians and staff to address findings, conclusions, and make specific recommendations. We will review the principles of documentation and provide guidance to help the physicians develop a clearer picture of the information the insurance companies, particular managed care companies, and Medicare/Medicaid require. We then show how the documentation determines the level of service selected for the encounter and provide pointers for increasing levels of service and revenues. We also show ways in which more comprehensive documentation allows the staff to select a more specific ICD-9 code as required by Medicare and private insurance carriers. We also discuss any legal or risk management problems identified.


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