Coding and Billing Consulting

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Our coding advisors also bring to the table a deep bench of expertise in coding and billing best practices and procedures and can provide assistance related to:

  • Performing coding compliance reviews for facility and professional services, as well as specialty providers
  • Assisting legal counsel with documentation, coding and billing reviews and engagements under attorney-client privilege
  • Providing coding compliance education for physicians, non-physician practitioners and therapists
  • Serving as co-sourced resources to conduct coding compliance auditing/monitoring for compliance and/or internal audit departments
  • Providing documentation analysis of physician and non-physician practitioner coding and billing of evaluation and management and procedural services to identify risks and revenue opportunities, including high-risk areas such as:
    • ‘Incident-To’
    • Scribe documentation
    • Copy/paste overutilization
    • Split/shared visits
    • Physicians at teaching hospitals (PATH)
    • Critical care services
    • Inpatient rehabilitation facility therapy
    • Analyzing provider evaluation and management bell curves to identify risks and revenue opportunities
  • Providing a risk-based approach to monitoring procedural and diagnosis code assignment and modifier application for physician practices and hospital outpatient services including:
    • Emergency room charge capture
    • HBO therapy
    • Facility evaluation and management
    • Radiology
    • Laboratory
    • Chemotherapy/oncology
    • Infusion services
    • Telemedicine compliance and education
    • Optometry
    • Covid-19 ICD-10 reporting
    • Behavioral health
  • Reviewing documentation for accurate hierarchical condition category capture, gap analysis and reporting