Outpatient and APC (Ambulatory Payment Classification) Audits
Amenity audits Outpatient Prospective Payment System (OPPS) claims, focusing on appropriate coding of the services billed to ensure accurate payment. APC bundling rules set forth by CMS and various industry standard entities are employed to ensure accuracy of the claims payment. We validate the appropriateness of charge as permitted by contracts and ensure that all treatment, services, and care are reasonable and necessary.