Coding Operations EvaluationOptimum reimbursement is wholly dependent on proper code choice. Whether your coding services are performed in-house, by the hospital, or through a proprietary agent, BSA Healthcare can evaluate your coding processes and policies for efficiency, compliance, and productivity.
Professional and Facility Services Coding Compliance AuditingMonitoring your practice’s coding and documentation via external medical record audits is critical to ensuring appropriate revenue and compliance with federal and state regulations. Routine medical record audits also prepare and protect your organization from increasing scrutiny by governmental and non-governmental payers. Audit services include pre- or post-claim submission evaluation, and focus on assessing any potential loss of revenue resulting from poor provider documentation or an overly conservative coding methodology.
Coding Reference MaterialsBSA Healthcare has created specialty-specific coding tool sets that are based on an interpretation of the Medicare Audit Tool, and over 17 years of coding methodology interplay with our client base. These tools can be used to supplement your current coding policy materials, or they can serve as a starting point in creating your own coding policy and procedures manual. Coding reference tool sets are available for the following specialties:
- Emergency Medicine - Professional and Facility Components
- Hospitalist Medicine - Professional Component
- Urgent Care - Professional Component
For Sample pages of any of our specialty-specific coding tool sets, please contact 888-568-4993.
Coder TrainingCoding seminars are delivered on-site and are designed to educate coders, and compliance and reimbursement personnel, in the nuances of specialty-specific coding. Coding seminars can be custom tailored for your organization, but typically include a comprehensive review of:
- Evaluation and Management (E/M) code choice
- Procedure codes
- Diagnostic code choice
- Critical care
- Fracture Care codes
- Observation and ultrasound codes
- Documentation guidelines.
Payer Audit Defense Appeals Strategy and PreparationAs concerns over the cost of health care and a strained national budget rise, efforts to reduce perceived overpayments to providers are similarly increasing. One of the most prevalent mechanisms used by payers to reduce healthcare costs is retrospective audits of those physician practices whose billing patterns differ from those of their peers, thus potentially suggesting fraud or abuse. Payers utilize the audit process in an attempt to uncover opportunities for significant overpayment recoveries, as well as to create the effect of encouraging physician practices to bill conservatively.
As unwavering physician advocates, the employees of BSA Healthcare have dedicated themselves to understanding the regulatory and response requirements that comprise the audit appeals process. To date, we have worked with emergency medicine providers nationwide to successfully manage the multi-step process of responding to deadline-driven payer audits.