The coding and claims review due diligence work stream is one of the most important areas in a healthcare M&A transaction.
At Coker, we understand that identification of red flags in the coding and billing practices of a healthcare entity during the due diligence process can be a deciding factor on whether to proceed with the transaction, or whether to add additional provisions or protections to the purchase agreement to address concerning findings. Further, accurate documentation, coding and claims submission is tightly regulated and scrutinized by payers and other regulatory agencies to prevent errors and fraud and abuse of the system. Identification of aberrancies in these areas allows for prompt correction and mitigation by the target entity/practice prior to close of the transaction, allowing the buyer to avoid fines and penalties, including large paybacks. Additionally, knowledge of the identified concerns pre-close allows for controls and improvements to be put in place promptly upon acquisition.
Our audit team includes certified professional coders and registered nurses, with experience and training in all physician practice specialties, with an emphasis on E/M, risk adjustment, including HCC, AWW and billing and claims submission. Our team of experts can ensure that red flags in the coding and claims submission process of the target entity are identified and communicated to the buyer to ensure prompt decision-making and planning in the transaction process. Our team can be deployed to evaluate the smallest provider practice or the most extensive healthcare system and reliably deliver high-quality advisory and audit services in this crucial area.
Our audit team can perform due diligence coding and claims audits of your target healthcare entity. Our advisors have expertise in CPT, HCPCS, ICD-10-CM/PCS, E/M, AWW, Risk-adjustment, and HCC coding. Additionally, we are knowledgeable about the coding and billing risks specific to the clinical practice area of the target enabling us to advise you on areas of specific focus to consider during the audit.