Ensure Coding Compliance

In this era of increased payer scrutiny, provider organizations must insure that their coded data contains few, if any errors. The entire health system revenue cycle system depends on accurate medical record data for pricing, research, quality of care measurement, and public health planning. Now that Medicare’s RAC auditors can recoup payments based on undiscovered coding errors, going back several years, providers must be proactive in recognizing errors to decrease further financial risk. Without performing annual external audits (recommended by the OIG) and having a monitoring system in place, organizations may be unknowingly putting themselves at risk of both under-billing and over-billing. Therefore, it is necessary that providers diligently analyze their claims for errors. AMS Consulting Services can provide an audit that meets your budget while clearly identifying the risk.

Our coding compliance auditors possess the skills and experience necessary to help our clients properly design and execute highly technical inpatient and outpatient coding reviews. We work closely with HIM and revenue cycle managers to plan the audit scope and the service areas to be examined. Through our initial client interviews we come to a clear understanding of the coding and billing processes, current monitoring activities, and past coding compliance audit results. Reviews can extend to an analysis of documentation, coding, claims, statements, and reimbursement; or they can be focused on specific aspects of coding compliance for various payers. Due to the unique nature of each healthcare facility, we are able to work closely with your organization to establish the approach, size and scope of the audit.

To learn more about how AMS Consulting Services can help you with your Coding Compliance, Contact Us