Professional Fee Services Coding
Our team conducted a baseline coding audit for a large physician group. This review included over 5000 encounters and focused on services provided in the hospital setting (outpatient and inpatient), including but not limited to evaluation and management and surgical procedures. Upon completion of each review, we provided immediate education to each provider that fell below established coding accuracy rates. Further, we provided executive summary reports with recommendations for each provider audited. The specialties covered during this review included: Cardiothoracic Surgery, Emergency Department, Endocrinology, General Surgery, Internal Medicine, Mid-level Providers (working under incident to guidelines), Obstetrics and Gynecology, Pediatrics, Psychiatry, and Urology.
Clinical Documentation Improvement
Our team conducted a documentation analysis of a medium sized physician group. Our review focused on Evaluation and Management levels, Diagnosis Accuracy and Specificity, Medical Necessity, Charge Capture, Quality of Care and Meaningful use. Based on our assessment, we provided education to staff and developed policies and procedures.
Compliance Programs for Physician Offices
Our team worked as the auditor for a company that was engaged as the Independent Review Organization (“IRO”) by an ambulance company to perform an analysis of services and to assess the effectiveness of the ambulance company’s compliance efforts in relation to terms of its Corporate Integrity Agreement (“CIA”). The CIA was mandated by the OIG pursuant to the discovery of certain billing and reimbursement violations. We conducted an analysis of a random sample of 50 ambulance claims to determine the accuracy of the facility’s claims. Our findings were communicated to the OIG via a written report.
Education and Training
Our team trained approximately 500 physicians and their staff on the ICD-10-CM coding system. All of our trainers are coding experts with more than 20 years experience and hold the designation of AHIMA approved ICD-10-CM/PCS trainers. Our CEO, Dr/ Lisa Campbell, PhD, MHA, MPM, RHIA, CDIP, CCS-P, CCS, CPC, COC, CPC-I, has been providing education and training services since 1997 and is an adjunct professor for several colleges and universities. In the past, we have conducted educational sessions on clinical documentation improvement, coding and compliance, just to name a few.
We conducted an operational assessment for a physician group that focused on all day to day operational areas of the physician’s practice. Upon completion of this assessment, we developed an action plan of areas that needed improvement and are currently assisting with implementing these recommendations.