Episode 2: The First Step to Compliant Coding - Finding the Right Coder

Jim Anliot, Director of Healthcare Compliance Services at Affiliated Monitors, Inc., features to discuss how best to navigate a federal program integrity agreement.  Not only can you prepare yourself for such an unfortunate occurrence, you can prevent it from happening too.  Tune in as we discuss what to expect, best practices to adhere to and stumbling blocks to avoid if your organization falls subject to a corporate integrity agreement or program integrity agreement with the OIG.

Sharon Nicka, founder and president of Nicka & Associates, joins the show to discuss the import of evaluating ED’s in your compliance program.  Covering hot topics in the emergent care space, the team delves into areas of concern to be mindful of and best practices to avoid compliance pitfalls.  Tune in to get the latest and greatest in the coding and compliance world as it relates to emergency medicine.

Independent reviews of a revenue cycle are crucial to ensuring the financial health of your organization.  Whether its looking at your organization’s processes to identify charge capture opportunities, validating coding accuracy, or maintaining compliance with the Department of Justice’s guidelines for compliance plans, independent reviews serve to provide senior leadership with clarity as to the efficiency and success of their revenue cycle teams.  Tune in as Ben Colton of ECG Management Consultants joins the guys to offer valuable insights and a meaningful discussion that all revenue cycle managers will want to hear!

Ensuring compliant coding begins with high-quality documentation.  This task need not fall exclusively on the shoulders of the physicians rendering services.  Whether it is to supplement existing efforts, assist providers that struggle to document sufficiently, or validate that everything is being captured at the point of care in the medical record, scribes can play a valuable role in optimizing revenue, decreasing denials, and avoiding compliance exposure.  Tune into the latest episode of the Coding Compliance Podcast as Cassy Panter and Charlie Coe of ScribeAmerica join the team in exploring the value and import of utilizing scribes to safeguard your providers’ documentation efforts.

CMS’s Targeted Probe and Educate (“TPE”) Program is yet another mechanism to ensure accurate and compliant claims are submitted for reimbursement to Medicare.  This episode Teresa Mason of Epstein Becker Green joins the team to delve into what do TPE’s consist of, how to best handle them and which steps can be taken ahead of time to avoid being targeted for a TPE audit.  Tune in to make sure you are prepared to avoid or survive a TPE audit.  

While outsourcing functions of the revenue cycle, often times it can feel convenient and synergistic to have one entity perform both the billing and coding functions.  But buyer beware, there are pitfalls to taking this approach.  The Coding Compliance Podcast Team explores what to look out for and consider when outsourcing billing and coding helping you avoid unforeseen deficiencies and ensuring you make the most informed decision when selecting the appropriate external support.

While auditing coding and documentation is critical to validating your compliance efforts, once you have results that fall short of your established accuracy threshold, remediation is the next step in the process. Figuring out who is subject to remediation, what that consists of and how to validate whether your measures worked are key elements to creating an effective response to deficient coding and documentation. Tune is as the team explores how best to craft a successful remediation strategy.

Selecting the right auditing team is critical to getting the feedback your organization needs to improve on any outstanding deficiencies.  This holds true whether you’re performing internal or external audits to validate your organization’s coding and documentation efforts.  The Coding Compliance Podcast lays out some of the key factors to bear in mind when picking your auditors and setting up an audit schedule to help you get the best compliance program in place.

Crafting a coding compliance plan hinges on setting clear timelines and standards for validating your organization’s coding efforts.  Determining how providers and coders must perform, when the veracity of their documentation and code assignment should be reviewed, the methodology for auditing their cases, and what to do if they fail to meet organizational standards are some of the key components for developing and implementing a plan that validates the integrity of your coding compliance.  Listen in as the team dives into this critical process and gives some pointers on best practices.   

Setting your organization up for success by intelligently resourcing your coding needs is the first step in any compliance program.  Join the team as they explore your options for selecting the best coding personnel upfront to ensure fewer issues down the line and help you create the foundation of a compliant coding program.