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Missy Stimler Staff Corner- #4 of 4

How does an audit form Edelberg work and help the client?
• EA is nationally known as a company that specializes in professional and technical coding and compliance. EA provides audits of
multiple specialties, including, but not limited to the following:

o emergency medicine
o hospital medicine
o outpatient clinics
o urgent care clinics
o Observation

• Our clients include hospitals, freestanding EDs, physician groups from a variety of specialties, compliance attorneys, insurance
companies, physician groups or organizations that are considering the purchase of other physician groups

• EA provides audits of coding for:

1. Compliance – Did the entity assign codes that followed the rules and regulations issued by the Federal Government or other
specific payers?
2. Reimbursement – Is there an opportunity to improve coding or documentation in order to ensure legitimate reimbursement for
the facility?
3. Physician or nursing documentation:
*Does physician documentation of History and Physical support the level of Medical-Decision-Making?
*Does physician documentation appropriately describe the patient’s condition and support a coder’s ability to assign correct CPT and ICD10 codes?
*Does physician documentation allow for correct coding of Evaluation and Management Levels?
*Does physician documentation support Medical Necessity of ancillary testing or procedures performed?
*Does nursing documentation support correct coding of procedures, infusions, injections, Critical Care?

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