Performs Charge Reviews on the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol, and other applicable documentation. The reviews may include the verification of billing data for accuracy and completeness, following regulatory requirements, to resolve edits or exceptions detected during system processing of the claim in the customer systems
Reviews that modifiers applied are appropriate based upon reviews, and/or makes necessary adjustments to patient account charges and/or balances
Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and standards
Evaluates if account combinations and account splits are appropriately applied
Aggregates charge capture issues, clinical documentation issues and revenue education opportunities to help clinicians understand their documentation responsibilities
Provides charge review results and presents findings to internal and client stakeholders
Coordinates charge reviews for retrospective or concurrent, and other billing reviews as identified
Reviews denial trends for documentation and missed charges/revenue opportunities and provides feedback on educational gaps
