Our Mock RAC audit includes: Review of the selected claims: Utilization review for medical necessity; Line-item review for correct billing and documentation of services; Coding review for: Bundled/unbundled services; Appropriate coding of documented services; Appropriate coding of diagnoses, as documented in the chart at the time of service. Utilization Management: InterQual utilization review standards will be utilized to determine appropriateness of admission and length of stay; RNs with UM experience will conduct the TTG review; TTG will report UM variances found to assist Management in identifying needed changes or education. Line-Item Bill Review will be performed by RN auditors To identify over and under billed services as documented in the medical record; TTG will apply Medicare regulations as to bundling and unbundling billed services; TTG will report to Management over and under variances by Revenue Code. Coding review will be performed by Certified Professional Coders to emulate the RAC vendor’s approach to the audit: TTG will audit CPT and ICD-9 coding; Coding variances will be reported to Management by line-item for CPT coding; TTG will report ICD-9 variances as billed on the UB-04. TTG’s Audit Process Includes: Identification of Project Coordinator(s) and the responsible personnel involved with the clinical and financial transactions for the Medicare billing cycle; Confirmation of on-site dates and the availability of key personnel; Review of organizational charts and data, including HCFA 1500 / UB-92/04, EOB/RA, Medical Progress Notes, Orders, Labs and other ancillary service documentation. Report of Audit Findings to Management: Exceptions and variances reported by revenue code;   Identify the UM findings;   Identify the bill audit findings;   Identify the coding audit findings. Please Contact Us if you would like more information or to request a proposal. Previous Page