Most practices assume a chart review is something you do after a payer comes knocking. By then you are defending decisions instead of correcting them.

We review charts the other way around. We look at what your providers documented, what was actually billed, and where the two do not line up. Sometimes that means you are billing for more than the note supports, which is a repayment risk. Far more often it means you are billing for less than the note supports, and you have been giving away revenue you already earned.

Every practice believes its coding is accurate until someone independent looks at it. Here is what usually turns up.

This is the single most common finding. A provider documents a detailed history, a full exam, and moderate complexity decision making, then bills a level three because it feels safer. Multiply a two-level gap across a full panel and the annual number gets uncomfortable.

The opposite problem, and the more dangerous one. If a note does not carry the medical decision making or the time to support what was submitted, that claim is a refund waiting to happen with interest attached.

Modifier 25 on a significant separately identifiable service. Modifier 59 on a distinct procedural service. These get dropped, or they get appended reflexively, and both patterns draw attention.

Chronic care management, transitional care management, cognitive assessments, care plan work. The visit happened, the documentation exists, and nothing was ever billed for it.

We pull a statistically meaningful sample rather than skimming a handful of charts. For most practices that means 10 to 30 encounters per provider, weighted toward your highest volume codes and any code where your distribution looks unusual against your specialty.

• Provider level E and M distribution compared against specialty benchmarks
• Line by line comparison of documentation to submitted codes
• Modifier usage patterns and whether they hold up
• Findings organized by provider so education can be targeted, not generic
• A written report with specific chart references, not a summary of impressions
• A working session to walk your team through what we found and why

You get the actual findings. Not a score. Not a percentage. The charts, the codes, and what should have happened instead.

Practices that have never had an independent review, or have not had one in several years. Practices where a new provider joined and nobody has checked their coding patterns. Groups preparing for a sale or an acquisition where a buyer is going to look hard at billing integrity.

It is also for practices that got a payer letter and need to understand their exposure before they respond.

Cyndi Walker has spent more than forty years in medical billing and holds certifications as a Certified Medical Coder and a Certified Healthcare Business Consultant. She speaks on coding, payer appeals, and payer regulations for the National Society of Certified Healthcare Business Consultants.

Medicus holds corporate accreditation from both HBMA and NSCHBC. When we tell you a chart does not support the code, that opinion carries weight in a payer conversation.

Enough to be statistically meaningful rather than anecdotal. For most practices that is ten to thirty encounters per provider, weighted toward your highest volume codes. A handful of charts tells you nothing you can act on.

It might, and that is a reason to do it rather than a reason to avoid it. Finding an issue yourself and correcting it is a fundamentally different position than having a payer find it. We will walk you through the options if something surfaces.

Annually for most practices. More often if you have added providers, changed your EHR, moved into new service lines, or had findings in a previous review.

Both, and undercoding is usually where the money is. Practices tend to assume audits only look for overbilling, so they are surprised when the larger finding is revenue they never claimed.

A chart review tells you where you stand. These are the services that usually follow it.

• Clinical Documentation Improvement to fix the documentation habits driving the findings
• Coding Education and Training to bring providers up to speed on what changed
• Healthcare Compliance to build the ongoing audit program that keeps this from recurring
• Revenue Cycle Management if you would rather hand the whole function over

Schedule a conversation and we will scope a review sized to your practice.