Coding Reimbursement (Medical Coding & Documentation Review)

Coding Reimbursement (Medical Coding & Documentation Review)

Are you concerned about your current documentation or coding practices? You can have confidence in the experts at DoctorsManagement for your medical coding and documentation review.As part of an effective compliance program, the OIG (Office of Inspector General) recommends an annual review of your practice’s medical coding and documentation. The highly-skilled coding and auditing specialists at DoctorsManagement will assist you in identifying and correcting vulnerabilities in your medical documentation, medical coding, medical billing, and reimbursement processes so that your coding and documentation support optimal reimbursement while reducing compliance risk.

No matter which type of medical facility or medical office you are in,  a physician office, group practice, multi-specialty clinic, hospital, or any healthcare provider in a healthcare setting — a comprehensive coding and documentation review from the medical coding specialists at DoctorsManagement will:

  • Pinpoint areas of risk leading to over or under coding and documentation
  • Uncover risk for COVID-19 and TeleHealth claims
  • Expose 2020 versus 2021 discrepancies
  • Reveal gaps in policies, procedures, processes, coding programs, or coding systems
  • Improve revenue integrity with proper coding and documentation
  • Equip your medical coders and auditors with the most recent guidelines and processes to maintain compliance with the regulations set forth by private insurance companies and government payors
  • Establish a benchmark for ongoing process improvement
  • Supply your team with easy-to-use reference guides
  • Teach your providers how to avoid pitfalls when using shortcuts such as EMR templates
  • Train your staff to communicate in a way that improves future results

How it works…

  • Coding and documentation audits can be performed remotely or on-site at your medical office
  • Your DoctorsManagement auditor will review a random selection of patient encounters to identify trends in your coding practices
  • Audit findings with specific results are discussed and reviewed with each healthcare provider
  • Throughout your review, you will receive guidance on best practices and how to address identified deficiencies and correct them
  • Educational sessions with each key staff member, biller, and medical coding specialist will provide hands-on training and feedback to ensure they are equipped to assign the most accurate codes
  • We will also include an evaluation of your practice’s fee schedule, modifier usage, utilization of CPT, ICD-10, and HCPCS coding, provider documentation, EOB denial trends, and productivity levels for Bell Curve analysis

What to do next…

  1. Contact us to discuss your specific audit needs by calling (800) 635-4040 or email [email protected].
  2. Read more: What can you expect from a coding and compliance review?

Why do thousands of medical providers trust DoctorsManagement to help improve their coding and documentation?

  • The quality and experience of our coders and auditors — All of our auditors, based in the United States, receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). Each team member has over 15 years of experience, are dually credentialed by the AAPC® (American Academy of Professional Coders) as Certified Professional Coders (CPC®) and Certified Professional Medical Auditors (CPMA®), and are proficient in the rules and regulations enforced by Medicare and commercial insurance companies.
  • Proprietary risk-assessment technology — Our auditing team uses ComplianceRiskAnalyzer (CRA®), a sophisticated analytics solution that assesses critical risk areas. By using this powerful tool, our auditors can identify the encounters that present the highest risk of triggering an audit so that they can be reviewed and the risk mitigated.
  • Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.

The full suite of DoctorsManagement solutions include:

Regulatory Compliance Consulting and Services

  • Compliance Auditing-Pre-bill Audits, Retrospective Audits, OIG RAT-STATS, Billing Analysis, Staff Training, and Education
  • OIG Compliance Plan Development
  • Appeal of Overpayment Demands
  • Medicare, Medicaid, and Private/Commercial Payers
  • Physician Training -Specialty Specific Training, Provider Shadowing, and Education, Chart Audits
  • Third-Party Compliance Officer for practices that do not have the capacity for hiring this position

Practice Operations Consulting and Support Services

How to Become a Medical Auditor

Certified Medical Auditors (CPMAs) utilize their knowledge of learning medical terminology, medical coding, and documentation guidelines to improve the revenue cycle of medical practices. A medical auditing career includes working with medical records technology and health services administration, applying your medical coding skills in a new realm. Associations such as NAMAS, AAPC or American Health Information Management Association (AHIMA) will give guidance on training for and certification exams, accreditation, and medical coding certificate if you would like to become a biller or coder.  A medical auditor career track can lead you to a rewarding position in offices charged with managing medical documentation, medical procedure documentation or medical services.  Types of courses include but are not limited to: certified coding associate, certified coding specialist, level ii coder, national certifications, CPT coding, procedure coding, certified professional coder certification (CPC), medical records review, icd-10 coding, CCS, or CCP designations, and the focus can be on inpatient or outpatient services.

Medical Coding Auditor Certificate & Exam Prep Course will help you pass the national board exam on the first try so you can become a professional medical auditor. Here’s what you’ll learn about in the course:

  • Medical Records
  • Coding Concepts
  • Reimbursement Methods
  • Quality Assurance
  • Risk Analysis
  • Scope Sampling
  • Modifiers

Interested in a career as a medical auditor? Visit NAMAS in our education section. DoctorsManagement is here to assist.

Call Us (800) 635-4040