Coding & Compliance
Resources For Managing A Complex and Critical Step
Safeguard revenue integrity in your revenue cycle
Clinical documentation communicates patient health history, facilitates coordination of care and ultimately drives better health outcomes. It also serves as the bill payers reference to determine reimbursement. And can also be a liability during a CMS audit. Documentation completeness and accuracy can be the gap between effective and ineffective care as well as revenue optimization and leakage.
Our Coding Team consists of AHIMA and AAPC certified professionals with decades of experience. Together, we’re able to help revenue teams bridge coding and compliance gaps within:
- ICD-10, CPT and HCPCS codes
- Inpatient and Outpatient services
- Professional fee, facility and consolidated services
Coding Outsourcing
Documentation & Coding Auditing
Finding and retaining coding professionals can be very challenging for providers within our current labor shortage reality. And it’s not exactly an entry level position with the needed medical knowledge and it’s complexity. Yet falling behind and submitting incomplete and inaccurate charts can create a significant revenue risks for care organizations.
HCM’s outsourcing services are a great option for clients with limited resources that understand the importance of partnering with a reliable and experienced team. Our coding outsource services have helped:
- Lower DNFB levels
- Reduced cost-to-collect
- Improved clean claims rate
Consistent internal audits are an essential function for recalibrating coding teams as workload pressures and interdepartmental communication can slowly steer things off track. But external audits should be sought out quarterly or annually, as well. External auditors can contribute fresh feedback to your coding and documentation efforts because it is unbiased and sourced from professionals with unique skillsets. HCM’s coding team approaches audits from three main perspectives:
- Operational: examining how and when coding is being performed during the patient journey
- Quality: measuring accuracy based on the story being told in physician documentation
- Compliance: verifying that documentation and codes are meeting the latest CMS guidelines
Our team can approach audits in the following ways:
- Prospective: audits on claims not yet submitted
- Retrospective: audits on claims that have been paid
- Targeted: audits on specific types of service areas
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