Auditing Tools

From Inpatient to Outpatient type coding audits, ReviewMate extends your auditing capabilities.

Man operating laptop with a graph notated as "risk"

CMS-HCC (Risk Adjustment)

The CMS-HCC (Risk Adjustment) auditing module is part of ReviewMate auditing suite. After uploading coded data, auditing can be accomplished in any of three ways:

  • Reviewers can audit each patients’ diagnosis codes on an encounter-by-encounter in a granular fashion.
  • Reviewers can access a listing of each patient’s missing HCCs and add them, if appropriate.
  • A listing of the diagnosis and HCCs missing from year to year, by patient, can be provided to interested parties to make decisions, such as, where to concentrate auditing efforts and what patients need to be seen in the current year.
Doctor sitting down at a table across the way from a patient.

Profee (Physician's Office)

The Profee auditing module is part of ReviewMate auditing suite and provides:

  • Accuracy rates for each element including: E&M, Non-E&M, CPT/HCPCS, Modifier, Diagnosis, Procedure Provider, Procedure Date, Service Units, and HCC
  • Physician Fee Schedule pricing for CPT/HCPCS codes
  • ICD-10-CM and CPT/HCPCS procedure code set
  • Code look-up
  • Full suite of references including CPT Assistant, Coding Clinic, Clinotes, Coders' Desk Reference and the AHA Coding Handbook
  • Optional E&M Form to assist auditors in determining the correct E&M components.
Close-up of two surgeons operating.

ASC (Ambulatory Surgery Center)

The ASC (Ambulatory Surgery Center) auditing module is part of ReviewMate auditing suite and provides:

  • Accuracy rates for all elements including: APC, CPT/HCPCS, E&M, non-E&M, Modifier, Service Units, Diagnosis, Procedure Provider, Procedure Date, and HCC
  • APC and fee schedule pricing and grouping
  • ICD-10-CM, ICD-10-PCS (optional) and CPT/HCPCS procedure code sets
  • Code look-up
  • Full suite of references including Coding Clinic for HCPCS, CPT Assistant, Coding Clinic, Clinotes, Coders' Desk Reference and the AHA Coding Handbook
Nurse taking a patient's heart rate.

OPPS (Outpatient Software)

The OPPS (Facility Outpatient) auditing module is part of ReviewMate auditing suite and provides:

  • Accuracy rates for all elements including: APC, CPT/HCPCS, E&M, non-E&M, Modifier, Revenue Code, Service Units, Diagnosis, Discharge Disposition (optional), Procedure Provider, Procedure Date, and HCC
  • APC and fee schedule pricing and grouping
  • ICD-10-CM, ICD-10-PCS (optional) and CPT/HCPCS procedure code sets
  • Code look-up
  • Accuracy rates by Patient Type (observation, ED, Clinic, etc)
  • Ability to assign responsibility on the line-item level to obtain individualized accuracy rates for the different contributors to the UB-04 (coder, charge team, radiology, etc)
  • Full suite of references including Coding Clinic for HCPCS, CPT Assistant, Coding Clinic, Clinotes, Coders' Desk Reference and the AHA Coding Handbook
  • Support for Pro Fee audit within the OPPS module
  • Identification of line items that were recalculated as a result of another line item revision
Doctor walking up to a patient with a mask on.

IPPS (Inpatient Software)

The IPPS (Facility Inpatient) auditing module is part of ReviewMate auditing suite and provides:

  • Accuracy rates for all elements including: MS-DRG, APR-DRG, SOI, ROM, Diagnosis, Principal Diagnosis, Secondary Diagnosis, POA, Discharge Disposition, Procedure (PCS), CPT/HCPCS (optional), Procedure Provider, Procedure date, MCC, CC, HCC and HAC.
  • Both MS-DRG and APR-DRG pricing and grouping
  • Code look-up
  • ICD-10-CM, ICD-10-PCS, ICD-9-CM and CPT/HCPCS code sets
  • Full suite of references including Coding Clinic, CPT Assistant, Clinotes, Principal Diagnosis Analysis, DRG Analysis, and the AHA Coding Handbook
  • Support for Pro Fee audit within the IPPS module
  • Identification on the screen of codes with MCC/CC/HAC/HCC value