Skilled Nursing Facility Services



Coding and Compliance Audit Services:

ICD-9-CM, DRG/MS- DRG, CPT-4, APC and E&M coding-"Catch Up" coding:

When backlogs occur our coding and classification professionals will be there to clear the way.

These options are available to our clients:

  • On-site coding: Our consultants come to your facility and perform the coding under your supervision.
  • Off-site/remote coding: You scan to our secured server (See for further information about this option) or fax copies of your records to us and within one business day we code and return to you the data you need to drop the claim. Alternatively, our information technology division staff will work closely with your organization’s information technology team to facilitate VPN access to your EHR or EDMS system.

Inpatient, DRG/MS-DRG, Outpatient, APC and E&M Compliance and Coding Validation:

Inpatient DRG/MS- DRG and Inpatient compliance and coding validation services for acute care and long-term acute care hospitals (LTACH) includes a comprehensive validation of DRG assignments to identify:

(1) Coder education needs;

(2) Education for your medical staff to enhance their documentation to assist your coders in their coding efforts; and

(3) Cases with potential changes that will result in improved reimbursement while remaining in compliance with various regulatory agency requirements.

Coding reviews are offered on a pre-billing or post-billing basis. This service identifies coding changes, complications, co-morbidities, or sequencing changes, which could increase reimbursement; identifies cases that may require payer refunds to ensure compliance with the organization's compliance plan; and potential medico-legal issues.

If necessary, our practicing, DRG and documentation proficient physician advisors will come on-site to work directly with your physicians.

Outpatient, E&M, and APC coding reviews are available to hospitals, ambulatory surgery centers, clinics, physician offices, and urgi-care centers. Our credentialed coding auditors assess the correctness and completeness of codes assigned, modifiers, sequencing, and APCs assigned. We review the client records and compare these to the UB and coding summary to ensure all the information is correct to facilitate complete reimbursement. These coding reviews assist the health information management department and patient financial services department to improve future coding by assessing the quality of coding performed for outpatient records reimbursed under the APC and RBRVS programs; providing training to coders and physicians in the use of the CPT coding conventions; reviewing ICD-9-CM and CPT code linkage; and assessing that the documentation is sufficient to justify the services billed.

Outpatient coding reviews are offered for all categories of outpatient coding including series/recurrent care, interventional radiology and cardiology services, therapies, emergency care, physician offices, clinics, and ambulatory surgery services and centers. For ER coding, our coding professionals have evaluated coding quality using many diverse point, service, and unique level assignment methodologies.

APC coding reviews are based on payer and recognized coding guidelines such as AMA’s CPT Assistant. APC coding reviews assist our clients:

  • identify if their staffs and chargemaster are accurately assigning codes,
  • analyze charge entry accuracy and timeliness by ancillary services, and
  • ensure data integrity from code entry in the abstracting effort through claim generation.

Outpatient coding reviews can be performed on- or off-site. Off-site services can be accomplished through a VPN connection or by using FirstCodeCentral, our off site coding application.

Coding Compliance Review Findings

As cases requiring coding revision are identified, these are shared with the coding staff to improve coding practices and compliance and to provide prompt feedback at the time of the review. Our approach has always been one of collaboration between our coding compliance auditors and the organization’s coding team.

Focused Coding Operational Assessments

An analysis of the processing flow may be conducted as part of our coding validation and compliance reviews. The assessment permits the healthcare organization or provider office to improve the timeliness of coding, claim submission, and identify methods to improve documentation to meet regulatory requirements. Our goal is to identify delays or bottlenecks and/or inappropriate or ineffective processes that impact the revenue cycle. Once identified, we will offer proven solutions that contribute to improving documentation and compliance while at the same time reduces days in revenue outstanding.

If physician education is required to improve the content or quality of documentation for the coding staff, our coding professionals can provide this education one-on-one or involve one of our practicing physician advisors in the process.

Custom In-Service ICD and CPT Workshops:

Our coding and classification consultants work with our clients to determine training needs and continuing education expectations for their staffs. Our workshops and inservice programs are tailored to address the client's specific concerns.

The training of coding staff improves accuracy of coding and DRG/MS-DRG, APC, and E&M assignment, reviews compliance issues, and provides staff with updated coding changes and regulatory guidance.

Revenue Enhancement Audits (Pre-Bill and Post-Bill charge audits):

Our ongoing pre- and post-bill charge audit programs are designed to identify both overcharges and undercharges, and to recover any net amounts due to the hospital, thus increasing income.

The concurrent or pre-bill audits assist in ensuring a "clean bill" the first time, reduces third party audits, reduces patient requests for audits, and allows for timely correction of charge errors by the source department.

Our retrospective or post-bill audits provide cash to the hospital, which would otherwise be lost and involves 100% review of all charge paying or percentage of charge paying accounts for maximum revenue recovery.

Routine reporting of the findings in our audits permits management to help correct billing problems and identify need for charge policy revisions.

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