Profee (Physician's Office) Module

The Profee (physician’s office) auditing module of ReviewMate provides:

• Accuracy rates for all elements including:

  • CPT/HCPCS (Current Procedural Terminology/Healthcare Common Procedure Coding System)
  • E&M (CPT codes in the Evaluation and Management chapter)
  • Non-E&M (CPT codes not in the Evaluation and Management chapter)
  • Modifier
  • Service Units
  • Diagnosis (ICD-10-CM and ICD-9-CM)
  • First-listed Diagnosis
  • Secondary Diagnosis
  • Procedure Provider
  • Procedure Date
  • CMS-HCC (Hierarchal Condition Category)

• Locality fee schedule pricing takes place within the software eliminating the need for auditors to “toggle” between other products and ReviewMate.

• Optional logic-based E&M Form tool allows auditors to analyze the provider note and determine the correct E&M level. The tool contains 1995 and 1997 criteria for encounters before 2021. The E&M Form is exportable for easy reporting and training.

• Full suite of references including Coding Clinic, CPT Assistant, Coding Clinic for HCPCS, AHA Coding Handbook, Coders’ Desk Reference, Clinotes and code look-up eliminating the need for an outside product to perform research.

• Identification on the screen of codes with CMS-HCC value.

• Full communication between auditors and coders within the software to discuss findings and recommendations.

• Reconciliation of rebuttals occurs inside of ReviewMate.

• Conversations between the auditor and coder are saved and can be accessed by any user.

• Accuracy rates are available real-time and can be “sliced and diced” to accommodate different situations and date patterns.

• Extensive library of customizable reports from raw data to Executive Summaries.

• Customizable dashboards to enhance the user experience.

• Multiple user levels allow view-only access to any interested parties providing transparency with your organization.

• “Audit the Auditor” module is available for a higher-level quality check of any review in ReviewMate.