Murer provides consulting services to evaluate and assess compliance with federal and state healthcare programs and related regulations to ensure appropriate and accurate physician coding for Medicare and Medicaid billing.

Specifically, Murer will review a random closed medical record sampling for each practitioner requested and offers on-site visit availability with expert physician coding affiliates to evaluate and assess the following items:

• Bills are accurately coded and accurately  reflect the services provided (as documented in the medical records);
• Documentation is being completed correctly in accordance with  “Documentation Guidelines for Evaluation and Management Coding” and “Official Coding Guidelines for ICD-9-CM”;
• All services are being captured to insure accurate reimbursement for all physicians;
• Services or items provided are reasonable and necessary;
• Provision of advance beneficiary notices as applicable;
• Occurrence of double billing resulting in duplicative payment;
• Occurrence of billing for non-covered services as if covered;
• Occurrence of misuse of provider identification numbers, which results in improper billing;
• Occurrence of unbundling (billing for each component of the service instead of billing or using an all-inclusive code);
• Occurrence of failure to properly use coding modifiers;
• Occurrence of clustering (coding/charging one or two middle levels of services codes exclusively, under the philosophy that some will be higher, some lower, and the charges will average out over an extended period of time);
• Occurrence of upcoding the level of service provided;
• Physician incentive practices;
• EMTALA compliance;
• Professional Courtesy;
• Retention of coding compliance records; and
• Establishment of an on-going continuing physician coding compliance program.

   

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