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Auditing and Compliance

The United States Office of Inspector General (OIG) conducted a medical record review of a random sample of Part B claims for E/M services in 2010. OIG concluded that 42.0% of the claims for E/M services were incorrectly coded and 19.0% lacked supportive documentation.  In total, Medicare inappropriately paid $6.7 billion for claims for E/M services in 2010 that were incorrectly coded and lacked documentation.

Senergene’s team of auditors and medical coders work side by side with you  to audit and monitor codes and claims. Utilizing our audit management tools,  our health care claims data review and analysis services enable healthcare organizations and providers to trend, analyze, and report on claims and other data that they generate on a daily basis.

Auditing and Compliance

Senergene offers comprehensive auditing services that produce results. From healthplans, providers, to employer groups, our highly-trained team of experts and suite of auditing tools identify claims errors and recapture lost accuracy. With a multi-tiered approach, our claims audit will identify areas of improvement, and over or underpayments.

Our suite of services include auditing, recovery, and fraud & abuse engagements, and are designed for healthplans, providers, and employers.

 

Medical Record Review

Medical Coding Services

When looking for a customized, personal approach to your coding needs, Senergene partners with you to develop a robust solution. Our coding experts ensure accuracy and compliance to provide you with the peace-of-mind of knowing your claims are processed correctly. Our services assist providers, employers and healthplans.

  • ICD (International Classification of Diseases)
  • CPT (Current Procedural Terminology)
  • CDT (Current Dental Terminology)
  • HCPCS (Healthcare Common Procedure Coding System)
  • HCC (Hierarchical Condition Category)
  • MRA (Medicare Risk Adjustment)

Medical Coding Services

Denial and Appeals Management

Challenges with denials for specialized services like genetics or specialty drugs?  Strengthen your financial integrity by reversing inappropriate commercial and government denials and recover lost revenue.  Allow Senergene’s team of clinical experts and coding tools manage every step of the appeals process for you and your patients, freeing your resources for other essential tasks. Let us help you recover revenue from inappropriate denials.

 

Denial and Appeal Management

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