REPAYMENT DEMAND? – 6 Ways a Coder Can Save Attorneys Time and Money

A medical provider contacts you regarding a recoupment request by the government or a commercial payer. In determining the strength of the payer’s case, assistance from an experienced coder can help you save time and money. Here’s how…

1. Decrease Your Case Work – A coder’s analysis of the documentation can help you determine whether it’s better to focus on mitigating damages (getting the repayment reduced to as little as possible) or to defend the physician’s billing decisions and questioning the integrity of the audit. Because an experienced coder can deliver this assessment relatively quickly, you gain valuable time to plan your response strategy.
2. Expand your service offering – In case you’re not aware, many coders have specialty-specific training and credentials. Having the support of a coder with relevant training gives you the opportunity to take on a wider variety of cases.
3. Third Party Opinion – While some law firms employ coders, there is also benefit to utilizing an outside coder who is not privy to client information or the carrier findings. This provides an unbiased perspective and can sharpen your appeal or defense strategies, translating into a more favorable outcome for your clients.
4. Statistical analysis – Most coders are not mathematicians and most mathematicians are not coders. Some coders do, however, work alongside healthcare statisticians. These coders usually have a better understanding of how carries calculate and extrapolate a sample error rate and apply it across all claims to determine repayment amounts. Coders with this type of knowledge are often more proficient in assessing the validity of a recoupment request.
5. Expert Opinion – Having a coder review the documentation is paramount in most any case. However, having a coder who can also provide expert testimony as a third-party reviewer can empower you with “court-ready” materials to help position your case for the best possible outcome.
6. Separating fact from interpretation – An experienced coder can assess rather quickly whether the findings can be defended when held up against the documentation guidelines as they are currently written. Moreover, he or she will remove all opinion and interpretation of the guidelines, which are often vague, and provide you with a neutral report that is based on fact and requires no further explanation.

Remember, we base the above benefits on the assumption that you are working with an experienced coder. That means he or she has performed coding reviews for physicians and/or their attorneys to assist in the process of responding to a repayment demand.

If you would like additional information or would like to further discuss this topic, call us at 800-635-4040 or email us at [email protected]. We’ll be happy to help you or point you in the right direction.