Medical Coding Audit | Claims Denial Mangement

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Recovery Management

Medical Billing Outsourcing at a Competitive Rate

Our Denials Management System means more accurate billing. And you get your money faster.

Medical coding is a fundamentally important aspect of maximizing reimbursement in today’s medical practices. Without the proper knowledge of medical coding and reimbursement methodologies, providers and practices will not receive the correct reimbursements, if any reimbursement at all.

In addition to Medical Billing Specialists, we employ Medical Coding Specialists with years of clinical experience in a vast array of medical specialties, and with CCS-P and/or CCS credentials.

Medical Coding

We assign the correct ICD-9, CPT, and/or HCPCS codes derived from the medical records and reports from your practice. We ensure accuracy and appropriateness of the codes submitted to maximize reimbursement.

Medical Coding Audits

We analyze your medical records and previous coding to ensure that if you are audited then your documentation will support the codes submitted.

Medical Coding Audits

Effective denials management and APC management has assumed greater significance in healthcare revenue cycle operations with the shift in reimbursement toward more prospective payment system(PPS) methodologies, coupled with an increasing proportion of services provided on an outpatient basis.

Hospital Outpatient Prospective Payment System claims error rates = (8%-30%)
Coding errors = 56%
HCPCS errors = 86%
CDM-originated = 79%
25% - 40% of all claims are either delayed via editing or are denied
50% of denied claims are never re-filed
90% of denials are preventable
67% of denied claims are recoverable

Accurate and Timely Reporting

Yet informative, detailed reporting at operational and financial levels for denials and APCs, based on actual payments, continues to be a critical need for many hospitals. Likewise, many hospitals remain uncertain if they are receiving appropriate reimbursement under the outpatient APC PPS.

With Medical-Billing.com, medical professionals have access to a wide range of reports that can be customized to your needs and can be accessed by you from any location over the internet. When you bill through Medical-Billing.com, medical professionals have access to a wide range of reporting features:

Easy access to their book of business to make knowledgeable business decisions – APC Frequency Reports, APC Utilization Reports

Easy access to their APC winners and losers from a $ perspective: APC listing by Medicare Allowable

APC Summary Report by Revenue Center

Claims Denial Management Reports

CPT/HCPCS Listings

Outpatient Case Mix Index

PS&R

Assess and identify problematic coding, billing, registration, charging and payment issues

Review charges from time of department entry to payment

Detail level APC payment reconciliation

Ability to See the problem then correct the problem

Thousands of legitimately billable and collectable dollars lost each week can be corrected and re-billed.

Accurate and Timely Reporting

In a typical healthcare system, about 20% of rejected claims are never resubmitted. A maze of policies, billing requirements and regulations, as well as complex managed care contracts contribute to the number of denials that go unattended. A Denial Management system can help you take control of your denials for more efficient claims processing and accelerated reimbursements.