re|code

re|code_RCM

Coding and Compliance

Overview

Value added coding services are designed with the understanding that each client may have one or more needs and or challenges related to coding. We have eliminated the cookie-cutter approach taken by so many coding services organizations by hiring team members who are experts in coding, and trained to recognize and report on opportunity and risk. Using this diverse team, we are able to create solutions for:

  • Inpatient and outpatient facility coding
  • Physician clinic, surgical and hospital coding
  • Prospective and retrospective coding reviews
  • Coding audits
  • Coding education
  • Coding edit and denial management services
  • Coding best practices and process improvements
  • ICD-10 coding

Challenges

Collecting payment for services rendered is essential to the financial performance of any healthcare organization and coders are key drivers in that process. Experienced and productive coders, a rare commodity, will be in even greater demand as the challenges of claim submission and reimbursement driven by ICD-10 draw near. Equally important, several forces are work to place revenue at risk by increasing the challenges faced by today's coders:

  • Increased coding complexity (e.g. ICD-10)
  • The Centers for Medicare and Medicaid (CMS) Recovery Audit Contractor (RAC) Program, which automates the review of complex cases
  • Increased demand for services from an aging population

Solution

We begin with a complete analysis of facility volumes and specialties to help us understand the coding needs of the facility. We then develop customized staffing analysis to determine the appropriate number of coders needed to complete the project based on either internal or agreed on productivity standards. Your re|solution team analyzes specialty and coding types to ensure a proper match with our qualified team of coders. Biographies for each coder listing their credentials, certification expiration dates, along with a listing of team members experience and specialties. We provide unique reporting and productivity tools with regularly scheduled reports to measure team performance, and adjust resources or focus as necessary. to ensure that best practices are sustainable, we can provide mentoring and training options for internal coders as well as educational materials.

For every review or audit performed, the re|solution team provides an executive summary, including an overview of sample size, error rates, and recommendations.

Our coding team is HIPAA compliant, and comprised of AHIMA and/or AAPC certified coders trained in the following specialties:

  • Inpatient facility coding
  • Outpatient facility coding
  • Cardiology, interventional, vascular and cardiothoracic
  • Neurology and Neurosurgery
  • Internal Medicine/Family practice
  • Pediatrics
  • Emergency Department (facility and professional fee)
  • General Surgery
  • GI
  • Urology
  • OBGYN
  • Psychiatric
  • Infectious Disease

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