problems

Hospitals, healthcare providers, and large enterprise healthcare organizations frequently face numerous challenges across the revenue cycle—from patient access and clinical documentation to billing, coding, and payer reimbursement. These issues often reduce efficiency, hinder financial performance, and create compliance risks. Without expert analysis and a comprehensive forensic review, many of these challenges remain hidden, leaving significant opportunities for revenue recovery and operational improvement unrealized.

Coding Errors and Inaccuracies

 Incorrect codes can result from various factors, including lack of training, misunderstanding of coding guidelines, or simply human error. These inaccuracies can lead to claim denials, underpayments, or delayed reimbursements.

Complexity of Coding Systems

The medical coding system, which includes ICD-10, CPT, and HCPCS codes, is complex and continually evolving. Keeping up with the latest updates and changes requires continuous education and training. However, many practices lack the resources to ensure their staff are always up-to-date. 

Inadequate Documentation

 Accurate coding depends heavily on thorough and precise medical documentation. Inadequate or incomplete documentation can lead to incorrect coding, as coders may not have all the information needed to select the appropriate codes.

Denied and Rejected Claims

 Claims can be denied or rejected for various reasons, including incorrect patient information, mismatched codes, or failure to adhere to payer-specific guidelines. Dealing with denials and rejections is time-consuming and requires a well-organized denial management process.

Insurance and Payer Challenges

 Negotiating contracts with insurance payers and understanding the specific requirements of each payer can be daunting. Differences in payer policies and reimbursement rates add to the complexity, making it challenging for practices to ensure they are receiving the appropriate compensation for their services

Lack of Staff

A shortage of qualified billing and coding professionals can leave practices struggling to manage these crucial tasks effectively. Inadequate staffing can lead to burnout, increased errors, and reduced efficiency in the billing process.

OUR SOLUTION

Our 30-day complimentary audit focuses on the prior six months of your billing and coding practices. During this period, we conduct an in-depth analysis to identify inefficiencies, errors, and missed opportunities that may be affecting your revenue cycle. Upon completion, we present a detailed report and targeted recommendations designed to increase your annual revenue by 10% to 20%.

BILLLING AUDIT

•  Patient records
• Billing codes
• Claims submissions
• Reimbursements
• Patient billing
• Payment posting
• Appeals
• Compliance
• Internal controls
• Financial reports
• And more

CONTRACT(S) REVIEW

 Provides insight into the terms and conditions of agreements with insurance companies. This analysis helps practices maximize revenue, ensure compliance, and streamline operations. 

IN-DEPTH ANALYSIS

CODING AUDIT

•  Code Assignment
• Documentation
• Upcoding
• Claim Form
• Payer compliance
• Special services
• Internal coding
• Denials & Rejections
• Fraud detection
• Financial Impact
• And more

INSURANCE PAYER UNDERPAYMENTS

 This can occur due to incorrect application of contract terms, payer errors, or misunderstandings of the contract's provisions. By identifying these discrepancies, practices can pursue the appropriate reimbursements

TARGETED RECOMMENDATIONS

10% - 20% ANNUAL REVENUE INCREASE

Our audit produces actionable data by examining medical billing and coding practices to uncover inaccuracies, inefficiencies, and opportunities for improvement. This data helps improve coding accuracy, enhance documentation, and maximize reimbursements. It also offers insights into payer compliance and denial trends, allowing practices to streamline processes and boost revenue. Our targeted recommendations will include a detailed ROI analysis and a plan to significantly increase your annual revenue.