Coding Support and Coding Compliance Audit Services:
Coding Support Services: Our coding support services are available for backlogs, short-term vacancies, and long-term outsource purposes. Our experienced, certified, and credentialed coding professionals have experience with most facility record types and professional specialties and are adept in one or more of the following areas:
- E&M (ProFee)
We can access your system through a designated VPN or Citrix connection or you can upload your records to our secured server.
Coding Compliance Audit/Review Services:
Our coding compliance and validation services assess the coding accuracy of your facility coders and/or your profee coders or providers, if they are applying the codes. These services are available for acute and long-term acute care hospitals, ambulatory surgery centers, skilled nursing facilities, specialty facilities, physician/provider practices, emergency departments/urgent care centers, and clinics.
Our coding compliance and validation reviews assist you in identifying:
- Coder education needs,
- Education for your medical staff to enhance their documentation to assist your coders in their coding efforts,
- Inappropriate or inadequate querying practices,
- Cases with potential changes that will result in improved reimbursement while remaining in compliance with various regulatory agency requirements, and
- Cases where the documentation does not support the codes claimed and may require refunding of payments to remain compliant with CMS and payer expectations.
Coding reviews are offered on a pre-bill or post-bill basis. This service identifies coding changes, additional conditions that should be coded, sequencing errors, modifier errors or omissions, present-on-admission accuracy, and disposition accuracy. Each of these may change reimbursement. When identified, cases resulting in a DRG or APC change are referred to the coding manager or coder for review and discussion with our reviewers.
Additionally, our experienced coding compliance team identifies other compliance related, chargemaster, and medico-legal issues that are observed during their review to allow you to take appropriate actions unrelated to coding.
Choose your coding compliance review need:
- Facility Inpatient and/or Outpatient
- ProFee Inpatient and/or Outpatient
- Freestanding Ambulatory Facility and/or ProFee
We’re ready to schedule your review.
Pre-Bill or Post-Bill Charge Audits:
Our ongoing pre- and post-bill charge audits have been conducted for both revenue enhance and litigation purposes and are designed to identify both overcharges and undercharges. These charge audits assist organizations to recover any net amounts due.
The concurrent or pre-bill audits assist in ensuring a “clean claim” the first time, reduces third party audits, reduces patient requests for a review of their claim, and allows for timely correction of charge errors by the source department.
Our retrospective or post-bill audits provide an opportunity for organizations to capture lost revenues and may involve a 100% review of all charges for those payers reimbursing the organization on a charge or percent-of-charge basis.
Routine reporting of the findings in our audits permits management to help correct billing problems and identify any need for charge policy revisions.
Customized Coding Education/Workshops:
Recognized for the comprehensive educational programs we provide, our clients continue to schedule customized inservices for their staffs. Our coding compliance and education professionals will work with you to determine the educational focus and continuing education expectations for your staffs. Often these programs will be pre-approved for continuing education credits from AHIMA and/or AAPC.
Providing routine education for your staff improves coding accuracy, morale, and retention, and provides your staff with up-to-date information on coding changes, Coding Clinic and other industry-respected coding guidance, and addresses how to deal with coding and documentation challenges.