Coding Support and Coding Compliance Audit Services:
Coding Support Services: Our coding support services are available for backlogs, short-term vacancies, and long-term outsource purposes. Our experienced, certified, and credentialed coding professionals have experience with most facility record types and professional specialties and are adept in one or more of the following areas:
✪ ICD-10CM
✪ ICD-10PCS
✪ CPT-4
✪ E&M (ProFee)
✪ MS-DRG/DRG
✪ APC
✪ HCC
We can access your system through a designated VPN or Citrix connection..
Coding Compliance Audit/Review Services:
Our coding compliance and validation services assess the coding accuracy of your facility coders and/or your profee coders or providers, if they are applying the codes. These services are available for acute and long-term acute care hospitals, ambulatory surgery centers, skilled nursing facilities, specialty facilities, physician/provider practices, emergency departments/urgent care centers, and clinics.
Our coding compliance and validation reviews assist you in identifying:
✪ Coder education needs,
✪ Education for your medical staff to enhance their documentation to assist your coders in their coding efforts,
✪ Inappropriate or inadequate querying practices,
✪ Cases with potential changes that will result in improved reimbursement while remaining in compliance with various regulatory agency requirements, and
✪ Cases where the documentation does not support the codes claimed and may require refunding of payments to remain compliant with CMS and payer expectations.
Coding reviews are offered on a pre-bill or post-bill basis. This service identifies coding changes, additional conditions that should be coded, sequencing errors, modifier errors or omissions, present-on-admission accuracy, and disposition accuracy. Each of these may change reimbursement. When identified, cases resulting in a DRG or APC change are referred to the coding manager or coder for review and discussion with our reviewers.