Services

Standard Audit:

Are the charges that appear on the itemized statement compliant with the patient’s medical care and treatment? Are they verified in the medical record documentation? FormScope verifies all charges and are supported by the appropriate documentation as recorded in the medical record by conducting a line-by-line review. This examination involves researching and documenting the precise location within the medical record of every item/service on the itemized statement and identifying charges that are not substantiated by the medical record.

Compliance Review:

Are the charges billed in compliance with federal billing regulations that govern inpatient and outpatient billing compliance? The areas addressed by this review include the propriety of items/services billed, unbundling of items/services, duplication of charges, and the incorrect use of CPT/HCPCS codes that are generated from the billing software which may be billed in conflict with CMS or AMA guidelines. With our compliance review, we can illustrate exactly how illegal hospital charges inflate all bills to payers. This area of auditing is able to yield more dollars that the standard audit by highlighting non-compliant billing practices used by most hospitals. Formscope ensures that all billed items and services are in compliance with the National Correct Coding Initiative and that provider billings adhere to the billing practices and guidelines established by the Physician’s Current Procedural Terminology (CPT) guidelines.

Pricing Analysis:

Do the charges billed meet the definition of fair and reasonable, usual and customary? Are the charges commensurate with the geographical conversion factor for that area? Are the charges comparable with, or in excess of, the 50th or 75th percentiles as established by Ingenix charge data for evaluating fees nationwide? FormScope will verify that the correct inpatient reimbursement is made by conducting a DRG validation of the codes used by the provider.