Audit-proof compliance for urgent care

An urgent care clinic in the Pacific Northwest expanded to include primary care and a small number of specialties. As service lines and patient volumes increased, so did payer audit risk. But the CEO and CMO didn’t have confidence that the existing overseas coding team could navigate the increasing complexities of payer compliance. As it was, they required strong oversight from clinical medical directors and errors were still making it through. The overseas team was already costing the practice $90,000 per month. Continuing the engagement was only going to bring increased costs rather than what the practice really sought: audit-proof documentation. 

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To give the practice the pre-billing compliance guarantee it needed, Charta implemented autonomous pre-billing chart review across a number of analyses, including:

• E/M leveling accuracy
• Correct modifier use
• Golden Thread integrity of documentation
• Verification of documentation support for all CPT codes
• Medical necessity assessments of tests, labs, and medications

By implementing AI chart review, the practice was able to end its $90,000 annual engagement with its overseas chart review vendor even as it increased the scope of chart review to achieve full pre-billing payer compliance across 100% of patient encounters.