Coding and Compliance Services
Coding and Compliance Support Services
Click here to view our service packages
Enforcement agency audit and appeal services
We have built a comprehensive team of coding, compliance and medical experts.We have the expertise to assist with all aspects related to RAC, MIC, MAC and other enforcment agency audits, including risk assessments, education and training, evaluation of extrapolated overpayments and preparation of appeals.
Physician acquisition due diligence
Our healthcare team will work in collaboration with you to perform a comprehensive practice review, based on the Office of Inspector General (OIG) compliance guidances, to identify critical areas that pose a compliance or operational risk to you and your company. We will provide you with a detailed analysis and recommendations based on the findings of our review. In addition, we are able to assist you in investigating any potential risk areas identified during the course of our review.
Physician medical necessity reviews
Independent review organization
Our team of experts is able to work with companies that have imposed corporate integrity agreements (CIA) and assist them with independent review organization (IRO) obligations imposed by the Office of Inspector General (OIG). We provide objective medical reviews and conduct an independent assessment of annual reports and claims review.
Coding and documentation review
Our certified coders will provide an objective analysis of your healthcare records. We will work in collaboration with you to perform a review of the accuracy and adequacy of your CPT, HCPCS and ICD-9-CM coding, using recognized standards, to assist you with your compliance efforts. Based on our findings, we will provide you with a detailed written report identifying any potential risk areas. We will also work with you and your staff to improve accuracy and compliance and decrease errors.
ICD-10 implementation
We are available to assist with mapping existing codes to the new code set, assist with documentation that impacts the transition to ICD-1o, and provide training and education for coders and providers.
Comprehensive third-party billing company performance reviews
Our team of experts will perform a review of all levels of the billing process, from claims submission through aging report analysis. Using standard objective measurements and criteria, we compare performance to national recognized industry standards, allowing billing companies and providers to assess performance.
Compliance plan review and implementation
Our certified healthcare compliance staff will assist you in analyzing your company’s existing compliance plan and policies and procedures, using published governmental standards. We also provide assistance in the development and implementation of a new compliance plan and policies and procedures, including education and training.
Customized education and training for staff and physicians
We offer training and provide education for both staff and physicians of multiple specialties. We create education and training materials customized for your specific needs and concerns. The materials are prepared utilizing current, recognized standards and guidelines. Training can be provided either onsite or by teleconference.
