| MS-DRG
Coding & Reimbursement Accuracy Audits
We provide a review of Inpatient coding and billing practices
to assess the accuracy and validity of ICD-9-CM coding, physician
and clinical documentation practices, as well as corresponding
Diagnostic Related Groups (MS-DRG).
APC Coding & Reimbursement
Accuracy Audits
We provide a review of outpatient coding and billing practices
to assess the accuracy and validity of ICD-9-CM and CPT-4 coding,
as well as physician and clinical documentation practices.
OIG High Profile Audits
We provide a coding review of the focus MS-DRG’s that the
OIG is monitoring for coding and documentation practices as they
relate to the Office of the Inspector General (OIG) and coding
compliance issues.
Coding Compliance Audits
We provide Inpatient, Outpatient, and Physician coding compliance
reviews with special emphasis on the following objectives:
- Assessing the accuracy of the ICD-9-CM and/or CPT-4 coding
and MS-DRG assignments. Identifying differences that may result
in case mix variances resulting in overpayments and underpayments
- Assessing the accuracy of the discharge disposition assignment
- Reviewing coding practices to identify any patterns and trends
- Evaluating the content, quality and availability of the medical
record source documents
- Assess and identify any mapping or billing issues
- Developing and maintaining components necessary for hospital
coding compliance initiatives and assist in providing corrective
actions for issues identified
- Assessing the content of the physician documentation provided
and identifying examples in which incomplete or inconsistent
documentation can affect coding specificity
- Recommending education for physicians pertaining to documentation
practices; and for coding professionals based on coding practices
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