Coding Compliance Services
Accurate medical coding plays a critical role in the overall functioning and success of health care organizations. However, coding is frequently an area of struggle for organizations. Coding and documentation inaccuracies often result in missed revenue and reduced cash flow and can jeopardize regulatory compliance, quality of care, financial integrity, and effective data management.
Strengthen your coding procedures and processes with comprehensive coding validation reviews that can help your organization streamline workflows, uncover opportunities, and develop a sustainable coding infrastructure. Our experienced certified coding professionals work with you to fine tune your coding program, ascertain areas of concern, and create a future-focused plan for going forward.
Explore how your organization can benefit from our comprehensive coding compliance services to improve coding accuracy, maintain compliance requirements, and strengthen your organization’s overall financial health.
Support Your Coding and Documentation Compliance
Complex coding and documentation requirements open the door to compliance issues, inaccuracies, and potential overpayments. Mitigate risk by developing a coding landscape that fosters accurate and compliant coding during the billing process, including abstracting information from medical record documentation and assigning the appropriate codes.
Our coding solutions focus on these key areas.
Medical Record Documentation and Coding Evaluation
Minimize the risk of claim denials and noncompliance with a coding review that evaluates the accuracy of your coding and practices. Our team of professional coders can help you;
- Evaluate coding and medical documentation for compliance with applicable regulations and guidance.
- Determine if coding has been accurately assigned and meets regulatory requirements as applicable by Centers of Medicare & Medicaid Services (CMS).
- Evaluate documentation, coding and billing practices that support compliant coding.
Focus areas include:
- Evaluation and Management (E/M)
- Office and Outpatient Procedures
- Medication and drug delivery
- Diagnosis code specificity and assignment
- Documentation improvement opportunities
- Adherence to National Correct Coding Initiative (NCCI)
- Documentation supporting national and local coverage decision policies
Baseline Reviews and Targeted Complex Review
Improve your organization’s coding accuracy by establishing a baseline and benchmark your results to it. A baseline review of your coding compliance can cover various aspects, such as:
- Coding Accuracy
- Documentation Review
- Compliance with Coding Guidelines
- Billing Practices
For more complex compliance adherence our team supports focused coding and documentation review for requested areas.
Ongoing Monitoring and Quality Assurance
Stay up to date with current regulations and help prevent organizational fraud and abuse by regularly monitoring your coding compliance program. Our team can help you integrate regular monitoring into your ecosystem which supports organizational efficiency and compliance adherence.
Backlog Assistance
Eliminate bottlenecks in your organization’s coding process and help increase business efficiency with professional backlog assistance. From complicated surgical cases to family practice, receive temporary assistance with charge capture or coding audits from our team.
Payer Audit Defense
From small physician practices to large health organizations, payer audit defense can help providers overcome financial penalties and audit denials completed by insurance companies. Receive guidance and analysis with Recovery Audit Contractor (RAC), Medicaid Innovation Collaborative (MIC), CMS, Office of Inspector General (OIG), and commercial payer payment requests.
Independent Review Organization
Receive objective and unbiased assessments that can support your organization’s growth and potentially help reduce overall liability. As an Independent Review Organization (IRO), we can help you with Corporate Integrity Agreement (CIA) or Tribal Health Program Agreement (THPIA) claims reviews.
Coding Department Redesign
Revenue cycle challenges can be caused by how a coding department is structured, its processes and procedures, and its management of both human and technology resources.
Identify areas of inefficiency, barriers to success, and potential risks with a comprehensive coding department assessment from Moss Adams. Our professionals evaluate existing systems to identify gaps, redesign opportunities, or clarification needs to align these systems with industry standards.
Medical Record Documentation and Coding Evaluation
Minimize the risk of claim denials and noncompliance with a coding review that evaluates the accuracy of your coding and practices. Our team of professional coders can help you;
- Evaluate coding and medical documentation for compliance with applicable regulations and guidance.
- Determine if coding has been accurately assigned and meets regulatory requirements as applicable by Centers of Medicare & Medicaid Services (CMS).
- Evaluate documentation, coding and billing practices that support compliant coding.
Focus areas include:
- Evaluation and Management (E/M)
- Office and Outpatient Procedures
- Medication and drug delivery
- Diagnosis code specificity and assignment
- Documentation improvement opportunities
- Adherence to National Correct Coding Initiative (NCCI)
- Documentation supporting national and local coverage decision policies
Baseline Reviews and Targeted Complex Review
Improve your organization’s coding accuracy by establishing a baseline and benchmark your results to it. A baseline review of your coding compliance can cover various aspects, such as:
- Coding Accuracy
- Documentation Review
- Compliance with Coding Guidelines
- Billing Practices
For more complex compliance adherence our team supports focused coding and documentation review for requested areas.
Ongoing Monitoring and Quality Assurance
Stay up to date with current regulations and help prevent organizational fraud and abuse by regularly monitoring your coding compliance program. Our team can help you integrate regular monitoring into your ecosystem which supports organizational efficiency and compliance adherence.
Backlog Assistance
Eliminate bottlenecks in your organization’s coding process and help increase business efficiency with professional backlog assistance. From complicated surgical cases to family practice, receive temporary assistance with charge capture or coding audits from our team.
Payer Audit Defense
From small physician practices to large health organizations, payer audit defense can help providers overcome financial penalties and audit denials completed by insurance companies. Receive guidance and analysis with Recovery Audit Contractor (RAC), Medicaid Innovation Collaborative (MIC), CMS, Office of Inspector General (OIG), and commercial payer payment requests.
Independent Review Organization
Receive objective and unbiased assessments that can support your organization’s growth and potentially help reduce overall liability. As an Independent Review Organization (IRO), we can help you with Corporate Integrity Agreement (CIA) or Tribal Health Program Agreement (THPIA) claims reviews.
Coding Department Redesign
Revenue cycle challenges can be caused by how a coding department is structured, its processes and procedures, and its management of both human and technology resources.
Identify areas of inefficiency, barriers to success, and potential risks with a comprehensive coding department assessment from Moss Adams. Our professionals evaluate existing systems to identify gaps, redesign opportunities, or clarification needs to align these systems with industry standards.
How the Process Works
Although each project is unique, our coding compliance projects follow a comprehensive six phase cycle that allows technical and non-technical elements to be addressed in tandem.
Our cyclical approach can be visualized like this:
Who We Serve
Organizations across the health care landscape look to our professionals for guidance, including:
- Physician practices
- Ambulatory surgery centers
- Federally qualified health centers
- Academic medical centers
- Behavioral health
- Rural health care
- Tribal health organizations
- Surgical services
- Risk adjustment
- Telehealth & digital health
- Hierarchical Condition Coding (HCC)
Expansive Health Care and Specialty Coding Experience
Deeply immersed within the health care industry, our professionals have extensive knowledge of the nuanced operations of medical coding. Our collaborative approach takes the time to understand the specifics of your business needs and strategically develop unique solutions contextualized among greater industry trends and activity.
Our coding compliance team combines their extensive operational backgrounds with health care experience, including certified coders well versed in coding processes and compliance issues as well as team members who are Certified in Health Care Compliance (CHC). This team has a strong background in regulatory guidance, medical documentation, and coding requirements, as well as industry best practices.
Our one-firm approach allows your organization to tap into the full resources of our firm, integrating guidance and solutions related to other integral support areas including finance, tax, and audit concerns, as well as internal audits, operational improvement, reimbursement, revenue cycle, and strategy and integration services.
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