An essential element of every healthcare organization’s compliance work plan is the performance of ongoing provider coding and documentation audits. Healthcare coding and compliance audit services are appropriate for all providers, especially highly productive providers who may find themselves under scrutiny for their billings by area-Medicare administrative contractors and other payers.
We understand that accurate reporting in healthcare requires extreme accuracy. Coding and billing processes are tightly regulated. Payers and other regulatory agencies audit to ensure compliance with state and federal guidelines.
Our audit team includes subject matter experts in a wide range of specialties, both AAPC and AHIMA certified advisors and trainers, and billing experts. Our qualified team can ensure that provider documentation is compliant and appropriate and represents all information reported to the payer. We audit all professional E/M specialties, and surgeries for organizations ranging from the smallest provider practice to the most extensive healthcare system.
With future value-based reimbursement models, the importance of accurate and compliant diagnosis coding is paramount. We have certified risk adjustment auditors with proficiency in HCC coding and education on our team to meet that need.
We understand it is not just coding and documentation that requires oversight; we also provide audits to confirm accuracy of “incident-to” reporting and conformity to the unique policies associated with Physicians at Teaching Hospitals.
Our deliverable is formatted to provide the necessary information in an easy-to-follow format without a lot of unnecessary clutter. We understand that providers want to get to the bottom line quickly. We provide information that is unique to each provider and provide overviews and recommendations for the practice or facility.
Electronic Health Records (EHRs), when used correctly can produce correct documentation that leads to accurate coding and reimbursement claims. Working with spreadsheets and books will never match the speed and efficiency of practice management software. Medical coding plays avital role in preventing denials, claim rejections, and proper reimbursement. Over the years, EHR systems have released several features to help with documentation, claims scrubbing, and code lookup/search.
Our technology team can ensure you have the appropriate EHR in place while our audit team can perform periodic or ongoing documentation and coding audits for inpatient, outpatient, and office-based professional physician services. Our advisors are skilled in CPT, HCPCS, ICD-10-CM/PCS, E/M, Risk-adjustment, and HCC coding. Additionally, we are available to present coding education and training for staff and providers, as well as advisory services around documentation and coding best practices.