Physician Orders and Nursing Documentation
Contractual Exclusions & Payment Policies
CMS Guidelines (if applicable)
Registered Nurse Auditors work on-site to compare the medical record to the line item bill on both inpatient and outpatient claims to ensure that all services performed were physician-ordered, billed supplies were actually used, billed medications were administered, and that billing complies with the provider contract. Likewise, outpatient claims that are paid APC/APG are reviewed to ensure that the proper coding was used.
Experienced Registered Nurses Perform Reviews
Historical Data to Focus Reviews