External Chart Audits

1. Assessing the potential loss of revenue resulting from poor documentation and/or conservative or incorrect code choice
2. Evaluating any compliance issues that may arise as they relate to code choice methodologies

External chart audits are performed according to client specifications and may include a review of one or all of the following:

1. Evaluation and management (E/M) and procedure code choices
2. ICD-9 diagnostic code choices
3. E/M and procedure code modifiers
4. Evaluating the link between CPT codes and ICD-9 codes on CMS-1500 claim forms
5. Comparing code choices to codes placed on the CMS-1500 claim forms by data entry personnel

1. A comprehensive review of each chart:
   a. Comparison of coder's results to BSA Healthcare auditors' results, with focus on E/M and procedure code choice
   b. The activities and elements (Medical Decision Making) found on each chart
   c. Additional notes from BSA Healthcare auditors describing specific areas related to each particular chart for the coders or the providers to review
2. An audit summary report listing differences in CPT or ICD-9 code choices between the client coders and the BSA Healthcare auditors.
3. E/M code distribution analysis reports comparing client coder distributions to BSA Healthcare auditors' distributions; a higher and lower code choice analysis is included displaying, per code, the number and percentages of these variances.
4. Procedure code analysis reports reviewing any differences in code choice between the clients' coders and the BSA Healthcare auditors.
5. Diagnostic code analysis reports comparing the client coders' code choices to the BSA Healthcare auditors' code choices.
6. A provider documentation deficiency summary report listing all charts that have documentation problems and the specific areas of these charts that have resulted in subsequent downcoding.

BSA Healthcare Services

EMERGENCY MEDICINE & PHYSICIAN SPECIALTY SERVICES Billing and Coding Operations Evaluation Billing Reports Review Documentation and Coding Seminars External Chart Audits Emergency Department Operations Analysis Practice Management Accounts Receivable Review and Valuation Compliance Risk Services Internal Collection Agency Startup and Implementation HOSPITAL SERVICES Pay for Performance Consulting Quality Improvement and Patient Safety Risk Services Operations Analysis Inpatient Services Outpatient Services Medical Record Audits Revenue Cycle Analysis EMTALA