Problem
A billing issue arose when a client was billed for a more complex service than what was actually documented. According to CPT guidelines, the required documentation did not support this higher level of service. Consequently, the patient faced an inflated charge because the bill exceeded what the documentation justified. Simply put, the patient was charged for a service more expensive than what was performed, causing a problem that needed resolution.
Solution
AuditPro's review of the case revealed that the service had been incorrectly billed at the 99215 level, when it should have been coded at the 99214 level. It was able to downcode the service to the appropriate level of complexity, reflecting the true nature of the care provided.
Outcome
This correction resulted in a total AuditPro reduction of 27%, a significant savings that not only mitigated the patient's financial burden but also reinforced the client's trust in the accuracy and integrity of their medical billing processes.
