Coding and documentation inaccuracies often result in missed revenue and reduced cash flow for many health care organizations. To help you strengthen your coding procedures and processes, our certified coding, auditing, and compliance specialists complete regular and targeted complex coding validation reviews as well as quality assurance programs in both inpatient and outpatient settings.

Our approach involves six stages:

In addition, we can help your organization prepare for ICD-10 transition. We leverage our own, customized tool for professional coding validation reviews, allowing us to create both standard and tailored reports based on the needs of your compliance or audit committee.

Our coding solutions focus on four key areas:

Inpatient Coding

We evaluate your clinical documentation for accuracy and completeness, process all pertinent data and hospital coding assignments, and verify the coding for completeness and proper specificity.

Outpatient Coding

Our team evaluates each component of your coding to help you meet or exceed the documentation elements required by federal and state regulators. So that all codes are verified as complete with the proper specificity, our consultants evaluate the clinical documentation and all pertinent data to verify that the appropriate code has been selected and assigned at the proper level of specificity. Typical areas of focus include procedure type, number or units, bundling, and adherence to national and local coverage decision policies.

Professional Fee Coding

We evaluate your coding and medical documentation for compliance with applicable regulations and guidance. For accuracy for the physician component, we evaluate two key areas: E/M coding and Procedures. Our team scrutinizes individual components of the providers’ coding to determine whether it has met, has not met, or has exceeded the documentation elements required by CMS. In addition, we evaluate the procedure documentation to determine whether it supports the CPT code selected and include focus areas of procedure type, number or units, bundling, and adherence with national and local coverage decision policies.

Hierarchical Condition Category Coding

How accurate are your organization’s HCC coding submissions? For your HCC capture to be successful, your diagnostic coding and medical documentation must be accurate, complete, and within all ICD-9 and ICD-10 coding and CMS guidelines. Our team can perform a comprehensive analysis of your HCC coding and documentation so you submit the most accurate codes with the highest level of specificity.

For each of these areas, we provide:

• Baseline review. We help you establish a baseline and benchmark your organization’s results to it.
• Ongoing monitoring and quality assurance. We regularly monitor your compliance program.
• Backlog assistance. From complicated surgical cases to family practice, we can provide temporary assistance with charge capture or coding audits.
• Targeted complex review. We offer focused coding and documentation review for requested areas.
• Payer audit defense. We can provide assistance with RAC, MIC, CMS, OIG, and commercial payer payment requests.
• Independent review. As an Independent Review Organization, we can help you with Corporate Integrity Agreement (CIA) claims reviews.
• Ad hoc assistance. We can lend considered professional advice and opinions on difficult questions.