Services

“According to the United States Department of Health and Human Services (HHS), for every dollar spent on healthcare-related fraud and abuse investigations, the government recovers $7.90. In 2016, the healthcare fraud prevention and enforcement efforts recovered $3.3 billion” (Source AAPC CPMA Course).

Every year billions of dollars are recouped by government and commercial plans due to provider’s coding and billing inaccuracy. Two significant reasons for audits are improper coding (code submitted does not match the services, billing twice for services) and exaggerated coding (billed higher service level than provided). In addition to keeping up with the coding and billing guidelines, it is also imperative to audit the medical records to ensure proper documentation, accuracy and prevent recoupments. Many providers only focus on providing training to their staff; however,they may overlook the importance of regular audits. 

Also, Payor audits and recoupments are other areas that make revenue forecasting challenging. Our medical records and claims auditing expertise will help your organization be proactive instead of reactive to the payor audits. 

The team at Revenue CycleBi has hands-on experience with coding and billing in different healthcare areas, including labs, physician’s office, outpatient and inpatient centers. Coding and Billing is the part of the revenue cycle that needs the most attention from the reimbursement perspective. Coding and Billing guidelines often change and can sometimes vary by payor and state. Also, our teams have shown their commitment and interest in coding and billing by obtaining several certifications from AAPC. 

Early on, our team will focus on identifying the revenue leakage in coding and billing. Our recommendations, when implemented, will restore the lost revenue and help your company stay financially healthy.