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The objective of the Coding Compliance Program is to minimize the risk of liability due to improper documentation or inaccurate billing that may result in fraud/abuse liability, including False Claims Act liability and Civil Monetary Penalties. Services covered under this contract represent a comprehensive and robust approach to validating the organization's coding practices, completeness and accuracy of documentation, and corrective measures which may be required to ensure the integrity of health insurance claims submitted by the healthcare organization.

Performed by a certified coder, we will audit charts for your organization. This review will validate the accuracy of your organization’s coding, documentation, and billing practices. Targeted services will include specialty-specific nuances of billing and coding for your organization. A “scorecard” and executive summary will be constructed to identify the areas of risk by relative value. This will be provided following the completed audit. Our review will encompass the following compliance and billing considerations:

  • CPT (procedure) code and modifier assignment
  • National Correct Coding Edits (NCCI) for bundling/unbundling issues
  • CMS National Coverage Determinations
  • Local Medicare Coverage Determinations
  • Review of orders for completeness and to determine if the order matches the tests performed
  • Assignment of appropriate ICD-10 (diagnosis) codes
  • (PATH) Physicians at Teaching Hospital Regulations, as necessary
  • Telehealth compliance

Revenue Cycle Policies & Procedures

Medical billing is one of the most highly regulated industries. The controls on medical billing are very tight and held at the highest level of scrutiny. A single error can result in lost revenue or fines. Therefore, part of your compliance and ethics program must include your billing compliance policies.The Federal and State Officer of Inspector General (OIG) expect that all compliance programs have these billing policies in place to safeguard the practice from submitting fraudulent claims and provide protection from FWA. The success of a healthcare organization relies largely upon effective management of the revenue cycle, and a comprehensive review of current billing processes, policies and procedures can ensure the organization stays in compliance with billing regulations and can even help uncover missed revenue opportunities.

Empower HCP provides a comprehensive review of your revenue cycle, billing, and coding processes, and can develop new policies and procedures where needed in order to meet governmental requirements and protect your practice. We also provide guidance on state and federal regulations, interpret payor guidelines, and assist with payor recoupment responses. There are various best practices an organization can integrate into the revenue cycle in order to follow payor policies and regulations and avoid clawbacks, audits, and legal proceedings.

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