We employ certified coders that have expertise in the specific specialization. With their skill and understanding, they can address the problems, maintain key performance standards base on payer specific documentations, use the proper medical codes and modifiers in accordance with AMA rules, and implement CCI (Correct Coding Initiative) amendments. Our coding team also carries out coding-related denial analysis, code corrections and resubmits the claims back to payers to improve reimbursements.

We offer multi specialty medical coding solutions:

• Coding staff augmentation
• Encompassing coding workflow
• Coding audits
• Compliance training
• Coding Education

Our coding teams are equipped with:

• Adhere to ICD coding conventions and official coding guidelines according to medical coding systems – ICD-10, CPT, CDT, CMS, AHA, AHIMA, and HCPCS
• Bundling and unbundling procedures
• Payer-specific requirements (Medicare, Medicaid, and all commercial insurance)
• Latest AMA and CMS guidelines, state / federal government compliance
• Collaborate with Client Managers to help and educate doctors and other clinicians in proper documentation techniques

How it works?

• Medical records are procured from the client’s EHR/PMS system via secured connection
• Validation of the information obtained
• Records are reviewed and CPT/ICD codes are assigned
• Quality Audit is carried for the coded charts
• Completion report is shared with customer

Validation of hospital inpatient claims requires comprehensive process flow to help with faster reimbursements for the services rendered. Diagnosis Related Group (DRG) and Clinical Validation Audits helps with success of payment integrity operations.

In order to verify coded elements like primary and secondary diagnoses, surgical procedures, present on admission indicators, and the disposition of the patient’s discharge as recorded by the doctor, DRG audits are carried out by coding specialists who adhere to official coding guidelines. They compare the hospital claim to the medical record. Working DRGs are frequently created soon after the patient is admitted, changed while they are in the hospital, and then completed upon discharge.

DRG analysts adhere to the necessary American Hospital Association Coding Clinic Guidelines and the ICD Official Coding Conventions by accurately documenting and reporting all significant factors affecting the DRG assignment and related reimbursement within the medical record.

What we verify:

• Diagnostic and procedural code assignments
• Present on admission indicator assignments
• Code sequencing
• DRG grouping assignment and associated payment
• MCC and CC when reported

We serve you better with:

• Actionable role-specific training is provided to the personnel as a direct result of the audit results. 
• Continuous process improvement is ensured through targeted training for coders, clinicians, case managers, and clinical documentation experts.
• A tried-and-true methodology discovers, monitors, and minimizes audit concerns while promoting superior clinical coding and documentation.
• Our teams have a proven record of adding value and enhancing compliance for medical facilities across the nation.

Clinical Documentation Improvement plays a major role in precise coding of a patient’s condition and requires an encompassing and organization wide effort. Our teams work cohesively to remove any coding errors and suggest proactive approach for delivering better and improved data resulting in better revenue cycle workflow. 

We provide tools and platforms where one can have a unified view of the compiled data with real time quality measurement alerts to optimize your HIM and Coding workflows, achieve better outcomes, and develop a best-in-class CDI program for hospitals, physician groups, and healthcare systems.

What we do:

• Advisory services to identify gaps and create a CDI programme
• operational assistance with coding and HIM tasks
• Auditing coding and educating clinicians
• Reporting CDI results and creating performance standards
• Updating the CDI impact with real time measurement of CMI, risk and quality measures, and staff productivity.

We serve you better with:

• Team efforts towards achieving CDI mission statements
• Analysing existing HIM, EMR and CDI resources and return optimization
• Developing a personalised educational plan based on competency
• Tracking individual and team performance to manage productivity
• Developing structural relationships between coding, physicians, finance and CDI teams.