Clinical Documentation and Coding Excellence

Medical codes and related regulations are constantly evolving, with hundreds of changes in the past year alone. Keeping abreast of these modifications can be time consuming and misdirect precious staff resources. Additionally, insurance carriers are becoming more aggressive in auditing medical records, increasing the need to ensure providers are educated in documentation guidelines. The Centers for Medicare and Medicaid Services estimates that up to 27% improper payments, more than $134 billion, were made in 2020 to only those programs it administers. This will likely translate to additional audits for both government and non-government payers.

Equally important is the need to identify and collect appropriate reimbursement for every allowable service performed. Our Certified Professional Medical Auditors perform objective coding and documentation audits to identify coding and documentation inaccuracies resulting in improper billing.  Internal staff is usually dedicated to daily processes, thus preventing them from performing this role effectively and objectively.

EisnerAmper has a dedicated health care team including Certified Professional Coders, auditors, billers and instructors with decades of experience who can both supplement your internal resources and provide objective reviews of current processes.

Our specialists can:

  • Review provider documentation for concerns and deficiencies
  • Maximize revenue collection by identifying and documenting all reportable services and conditions
  • Mitigate risk of revenue loss due to carrier audit
  • Provide Clinical Documentation Improvement (“CDI”) Training

Our services include:

  • Coding and documentation reviews and audits
  • Coding and CDI education for providers
  • Review, support and train internal coding staff
  • Review and education for CPT, HCPCS, ICD-10 and MS-DRG assignments

We offer customized support to your hospital, physician group, faculty practice or ancillary service organization at the level of involvement that best meets your needs.

Coding and Documentation Expertise

Our Health Care Services Group specialists are well-versed in the intricacies of billing and coding for providers and facilities, including complex specialties. The Coding and Documentation Team has deep expertise focused on coding and documentation audits, including chart review and provider and staff education, clinical documentation improvement, audit risk mitigation and regulatory compliance, charge capture and charge description master support. They have proficiency in payment and coding systems, including DRGs, APCs, APGs, CPT, HCPCS and ICD-10, and utilize revenue cycle management experience to advise on enhancing operational performance.  Their accreditations include Certified Professional Coders and specialties: CPC, COC, CPB, CPMA, CPC-I, and COPC, and recognition as a Fellow by the American Academy of Professional Coders. Their guidance and insights, driven by a wealth of practical experience and specialized training, have made significant enhancements to health care organizations dealing with increasing demands and skyrocketing costs.