Required List of Items for Auditing

Facts About Stark Medical Auditing:

  • Our audits exceed the AMA and OIG recommendations for claims auditing
  • We are a member of the Association of Healthcare Auditors   

 

Auditing Requirements

Here is a list of items we require for each audit:

  1. Practice overview noting all sites and types of billing performed
  2. Group details including Tax ID Numbers and names of the physicians in the group(s)
  3. A review of the current work flow process
  4. Percentage of claims sent electronically
  5. Percentage of clean claims sent the first time
  6. Average days to billing of claims
  7. Edits:
    • CCI edits
    • Timely edit cleaning process
    • ICD-9 edits & ICD-10 crosswalks
  8. PQRS tracking:
    • Copy of all current fee schedules or charge master (preferably in excel format)
    • Copies of all revenue centers included in the billing
    • A detail of the billing cycle
    • Standard set of monthly EOM reports detailing the past 36 months billing:
      • Summary of gross charges billed by month
      • Summary of payments posted by month
      • Summary of adjustments taken for the month with detail by carrier
      • Summary of charges billed by date of service by month
      • Number of accounts billed for the month
      • Summary of billed charges by CPT by month by date of service (CPT utilization report)
      • Accounts receivable aging report – by date of service
      • Totals for accounts sent to collection for the month
      • Refund totals for the month
      • List of charges and payments by carrier for three years

 

Additional Items Needed:

  1. A copy of the most current list of missing charges
  2. A copy of the last denial report
  3. A copy of the last missing demographic list
  4. Billing company contact information
  5. Copy of the billing company contract
  6. Contact information for current collection agency
  7. A copy of the collection contract
  8. The current managed care contracted listing
  9.  Copy of all current managed care contracts on hand
  10.  Copies of any other contracts or agreements, i.e., outpatient surgery centers, PHOs etc.
  11. A copy of the Part A contract(s)
  12. Details on any purchased service billing and payback arrangements
  13. 200 cases from six month prior to the signing date with CPT codes on them – this is for each practice audited
  14. Expenses related to billing if the process is in-house, if the client desires to have these costs reviewed
  15. Copy of compliance plan and notes
  16. Other items as requested