• Electronic Medical Records (EMR)
• Scheduler with Eligibility Test
• Compliance Management
  + Core Elements
  + Regulatory Risks
  + Auditing and Monitoring
  + Documentation Guidelines
  + Audit Exposure Evaluation
• Data Entry and Payment Posting
+ Charge Entry
• Superbill Interface
• Variety of Claim Entry Formats
• Fax
+ Demographic Data Entry

• Coding
  + Coding Consistency
  + Discovery of Undercoding
• Claim Submission to Payers
• Patient Invoicing
• Follow Up
  
+ Discovery of Underpayment

• Transparency, Analysis and Reporting
• Quality Control
  + Billing Process
  • Payment Distributions
  • Days in A/R
  + Claim Validation
  + Patient Eligibility Testing
  
• Data Center
  

Proper Documentation Guidelines *)

1. The medical record is complete and legible
   
   
2. The documentation of each patient encounter includes
     a. the reason for encounter;
     b. any relevant history;
     c. physical examination findings;
     d. prior diagnostic test results;
     e. assessment, clinical impression or diagnosis;
     f. plan of care;
     g. date and legible identity of provider
   
   
3. If not documented, the rationale for ordering diagnostic and other ancillary services can be easily inferred by an independent reviewer or third party who has appropriate medical training
   
   
4. CPT and ICD-9 codes used for claims submission are supported by documentation and the medical record
   
   
5. Appropriate health risk factors and changes in treatment or diagnosis are identified

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* Much of the material for this section of the website follows “Understanding Compliance: A Program Guide Based on the OIG 2000 Guidance,” by R. Saner, M. Spindel, A. Nordeng, Powers, Pyles, Sutter & Verville, P.C., MGMA, 2000