PROSPECTIVE CODING AND BILLING REVIEWS

Medical practice coding and billing has become a complicated and difficult task Therefore, as an extension of a practice’s compliance plan, physicians should carry out periodic prospective billing and coding reviews statistically consistent with those carried out by the OIG. Practical Healthcare Solutions LLC (PHS) has assisted physicians in the prospective sampling of patient coding and billing practices in order to:

• Ensure coding is consistent with the level of care rendered in order to maximize reimbursement and simultaneously prevent “up coding” based on the services rendered.
• Evaluate the efficiency and effectiveness of encounter and claims processing.
• Evaluate practice operating effectiveness.

  Additionally, PHS has assisted practices:

• Improve status of accounts receivable.
• Improve the accuracy and timeliness of follow-up processes and procedures; and
• Carry out other operational reviews as needed.

The prospective coding analysis is shared with the physician and office manager so any changes in coding can be implemented immediately prior to actual submission of any claims. These changes are subsequently documented along with any recommended policy and procedure modifications and are reinforced through physician and employee education.