Chart Review
A chart review is taking a representative sample of charts and ledgers to identify billing errors and assess the quality of your chart documentation. A consultant will examine a sample of medical records and the associated claims for reimbursement, particularly for Medicare beneficiaries, to identify errant billing practices as well as practice patterns.
We also look for ways to optimize reimbursement. When errors are identified, we quantify the frequency and magnitude of the erroneous claims and estimate the economic impact on collections.
Our findings are memorialized in a comprehensive written report. Your report is unique and confidential. It is recommended that the results be shared with the physicians and selected staff members as a basis for discussion and improvement.
In review, we follow the same protocol employed by Medicare during their post payment reviews for program integrity. We provide conservative recommendations to keep you beyond reproach. We believe that our approach provides a fair assessment of the quality of your practice management.
When considering a chart review the practice must decide the motive, scope and depth of a chart review. Corcoran Consulting Group has developed a tool to help sort through the initial questions to help narrow the TYPE of review that needs to take place. The audit questionnaire has no right or wrong answers, but the different concepts can be significant in determining the end result.
Chart Review Options:
Onsite vs. Offsite: Onsite suggests that the consultant travels to a specific practice location to review the claims in a retrospective or prospective manner. This would be recommended for a larger practice. Offsite implies that the charts and records are prepared and shipped to the headquarters in California. This usually requires more advance work for a practice and is recommended for a one or two doctor practice. Both have their advantages and cost saving factors.
Retrospective vs. Prospective: In a retrospective review the consultant will examine the past charts and documentation for a date of service, half-year of service or a full year of service. The numbers of charts vary according to sub-specialty and usually include MDs, ODs, optical, ASC and anesthesiologists. A prospective chart review involves holding the claims before they are actually processed and making the necessary changes and recommendations to correct the claim before it is actually filed. Both types of reviews carry legal responsibilities if errors are found.
Formal vs. Informal: A formal chart review includes a comprehensive and qualitative report. It includes a Utilization Analysis to present practice patterns. In addition to the time spent on the project, the consultant will also moderate a post-audit call to discuss questions, and make recommendations for improved billing and coding. An informal chart review is a very casual approach compared to the formal chart review and is only conducted onsite. CCG considers this process to be a “spot check” or a “pulse” or a “glance”. There is not enough comprehensive or statistical data collected to provide a comprehensive report. The findings are shared one-on-one with the doctor or administrator and no formal or written follow up will follow. The consultant may send some suggested reading to address the general topic.
Considering a Chart Review?
Following is a series of questions to help determine the motive, scope and depth of the chart review (audit) process. Each practice’s needs are different and your answers to these questions will help us determine the best way to assist the practice with its needs. There are no right or wrong answers, but the different concepts expressed in columns A and B can be a significant aid in determining the end result.
DETERMINE MOTIVE:
What has prompted the request for an audit and how will the audit results help you?
- I just want to know if we are doing things correctly.
- I want to find out how we would do in the event of a Medicare audit.
- I want someone to review our coding and documentation.
- I could use some help analyzing a recent change (i.e., new doctor, new ASC, sale or acquisition).
- We recently received a request for records from Medicare, and I am anxious about it.
- I think we may have an unhappy employee (or former employee) who could be a whistleblower.
- I’ve received a subpoena for records.
- We have a compliance plan, and an annual audit is required.
- We are under a Corporate Integrity Agreement with the OIG and it requires annual audits by an outside auditor.
DETERMINE SCOPE:
Is there a specific issue involved, or is the concern broad-based?
- There is no specific concern.
- I want to look at all types of services.
- I want to review claims for all payers.
- The issues are broad.
- I want the review to be comprehensive.
- I want to review a specific doctor, location, or department.
- I am interested in only exams and tests.
- I want to focus on particular surgical procedures.
- I only care about Medicare or Medicaid claims at this time.
DETERMINE TIME FRAME:
Will the audit include past claims, or do you want to review claims before they are submitted?
- I only want to look at services that have not yet been billed. This way I can make corrections before claims are submitted (prospective).
- I want to look at claims that have already been submitted and paid (retrospective).
DETERMINE TYPE OF REPORT:
Is the report to be subjective and qualitative, or do you expect it to be quantitative?
- I want a verbal report only.
- I want a written report with suggestions for improvements.
- I would just as soon have the report take the form of a letter; nothing too formal.
- I expect a comprehensive report with statistical analysis of errors.
- I want detailed, quantitative information related to specific charts.
Chart Review Considerations
Before a chart review takes place at a practice, a number of considerations must be made in order to determine the scope and logistics of a chart review. The fill-in-the-blank table below will allow you to outline some preliminary information for the chart review. Alternatively, click here to download as a .doc, or here to download as a .docx.
| How many of each? | ||
| Ophthalmologists | Surgeons | Non-Surgeons |
| General Ophthalmology | ||
| Cataract / Anterior Segment | ||
| Cornea / Refractive | ||
| Glaucoma | ||
| Retina | ||
| Pediatric | ||
| Oculoplastics | ||
| Neuro-ophthalmologist | ||
| Optometrists | ||
| Ambulatory Surgery Center(s) | ||
| CRNA(s) / Anesthesiologist(s) | ||
| Optical Dispensary(s) | ||
|
Satellite Office(s)
|
Are all the charts stored in one location? Yes / No | |
How many years of services would you like us to review?
[ ] Current services only
[ ] 1 year
[ ] 2 years
[ ] More than 2 years