ProFee
E&M Auditing & More
ProFee, or professional fee, refers to coding and billing the physician side of a patient encounter. ProFee coding covers the work performed by the provider and the reimbursement they will receive for the medical services performed.
Because Profee billing directly affects providers, it can be more strict than other types of accounts. Because of the narrow margin for error as an auditor, ReviewMate is prepared to address the exact punctuality you need.
ReviewMate E/M auditing tool ensures that physicians’ offices provide the correct information for insurance reimbursement by analyzing complex code assignment options and identifying opportunities for increased revenue, including ways to reduce compliance risks.
In addition to ReviewMate's standard features for auditing, our Profee module features:
- Optional logic-based E&M Form tool allows auditors to analyze the provider note and determine the correct E&M level. The tool contains 1995, 1997, and the new 2021 criteria. The E&M Form is exportable for easy reporting and training.
All auditing account types are considered part of the core of ReviewMate's auditing system that covers many features such as:
- Customizable settings for analyzing overall accuracy rates. Adjust for particular coders, tasks or firms.
- Built-in code look-up for performing research intuitively.
- Conversations between the auditor and coder are saved in a chronological manner and can be accessed by any user.
- Customizable dashboards to enhance the user experience.
- Identification on the screen of codes with CMS-HCC values.
- Grouping and pricing take place within the software eliminating the need for auditor to "toggle" between an encoder and ReviewMate for better resequencing decisions.
- Full suite of edits/warnings including gender and age conflicts, MCE edits, critical error and TruCode warnings.
- Accuracy rates available real-time and can be sliced and diced to accommodate different situations and date patterns.
- Multiple user levels allow view-only access to any interested parties providing transparency within your organization.
- Full suite of references including Coding Clinic, CPT Assistant, Coding Clinic for HCPCS, Clinotes, Principal Diagnosis Analysis, DRG Analysis, and AHA Coding Handbook
- Reconciliation of rebuttals occurs inside of ReviewMate.
- Extensive library of customizable and exportable reports from raw data to Executive Summaries.
- "Audit the Auditor" available for a higher-level quality check of any audit in ReviewMate.
What is an E/M Auditing Tool?
ReviewMate E/M (Evaluation and Management) auditing is part of our ProFee Module; it is designed to assist auditors in assessing the accuracy and compliance of E/M coding in medical records. It helps ensure that the service levels documented in the medical records align with the appropriate E/M codes defined by the Current Procedural Terminology (CPT) guidelines.
E/M Coding Guidelines Integration: Integration of the latest E/M coding guidelines established by the Centers for Medicare and Medicaid Services (CMS) and other relevant regulatory bodies.
Scoring and Compliance Assessment: Scoring mechanisms to evaluate the compliance of E/M coding with industry standards and regulations, providing detailed insights into potential areas of non-compliance.
Educational Resources, Coding Edits, and Training Modules: Access to educational resources to help coders stay up-to-date with the latest E/M coding guidelines and best practices.
Real-time Feedback and Recommendations: Real-time code lookup and code information details to guide reviewers to accurately identify the appropriate E/M codes based on the documented patient encounters.
Customizable Reporting: Customizable reporting features allow users to generate comprehensive reports highlighting coding trends, areas of improvement, and compliance status.
Integration with EHR Systems: Integrating Electronic Health Record (EHR) systems to streamline the E/M coding process and facilitate seamless data transfer between healthcare IT platforms.
Compliance with Regulatory Standards: Adherence to relevant regulatory standards, including HIPAA (Health Insurance Portability and Accountability Act) regulations and other industry-specific compliance requirements.
Audit Trail and Security Features: Robust audit trail functionalities and security measures to track user activities, maintain data integrity, and ensure the confidentiality of sensitive patient information.