Service Scope & Methodology
Pre-billing quality assurance is the final protective firewall between your clinical documentation and CMS clearinghouses. Our QA audit specialists review the full clinical episode record—including physician orders, face-to-face encounters, visit notes, supervisory visits, and skilled nursing documentation—to verify compliance with CMS Conditions of Participation (CoPs). We catch missing signatures, inconsistent notes, and non-covered services prior to claim generation, drastically reducing ADRs and post-payment recoupments.
Key Scope of Work & Clinical Deliverables
Independent Second-Level Chart Auditing
Rigorous pre-billing audits verifying that all skilled nursing, therapy, and aide documentation meets medical necessity requirements.
Face-to-Face (F2F) Encounter Validation
Scrutinizing physician F2F encounter notes to ensure timeliness, structural validity, and explicit clinical correlation to the primary skilled need.
Conditions of Participation (CoP) Compliance
Ensuring comprehensive compliance with CMS 484 regulations, individualized care planning, and patient rights documentation.
Targeted Probe and Educate (TPE) Defense
Pre-audit packet reviews and defensibility preparation to withstand MAC Targeted Probe & Educate audits and UPIC investigations.
Clinician Chart Deficiency Feedback
Detailed, actionable feedback logs provided to your clinical management team to educate field clinicians and eliminate recurring documentation flaws.
Pre-Claim Review (PCR) Protocol Alignment
Full compliance verification for agencies operating in states under CMS Review Choice Demonstration (RCD) protocols.
Supported Electronic Health Records (EHRs)
Our teams work natively inside your agency's existing EHR environment using secure, direct-access credentials with zero disruption to field clinicians:
Request a Chart Audit
Interested in Quality Assurance Review? Connect with our operations team for a confidential turnaround assessment and sample audit.