Healthcare Coding and Compliance Audit

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.

At Coker Group, we understand that accurate reporting of clinical, quality, cost, and financial data in healthcare requires expert translation of clinical documentation into coded data utilized for a variety of databases. Further, the coding process is tightly regulated and scrutinized by payers and other regulatory agencies to prevent errors and fraud and abuse of the system. With future value-based reimbursement models, the importance of accurate and compliant risk adjustment coding is paramount.

Our coding team includes certified experts in all relevant areas, registered nurses, health information management professionals–physicians with experience and training in coding, risk adjustment advisors with proficiency in HCC coding and education, AHIMA and AAPC certified advisors and trainers, and billing experts. Our qualified and credentialed panel can ensure that codes are accurately translated into invoices. Our team can be deployed to the smallest provider practice or the most extensive healthcare system and reliably deliver high-quality advisory and audit services in this crucial area.

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 coding team can perform periodic or ongoing documentation, coding, and medical necessity audits for inpatient, outpatient, and 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.

Contact one of our experts to learn more about our healthcare coding and compliance audit services.