Coding

Proper and accurate coding of medical records is essential to ensure full payment for services rendered. Frequent changes to codes and coding procedures require hospitals to continually review their coding procedures and educate staff and physicians regarding appropriate coding methodologies. PCS offers coding reviews and training sessions in the following areas:

Outpatient Reviews & Training - APC's and APG's Inpatient Reviews & Training - DRG's Departmental Focused Coding Reviews & Training

Outpatient Coding Review

The ever-changing rules and regulations of Medicare's Outpatient Prospective Payment System (OPPS) and other payers have resulted in inaccurate billing and reimbursement for many hospitals and health systems.

Correct coding of claims based on Ambulatory Payment Classifications (APC's) is essential for timely and appropriate reimbursement, improved revenues, reduced operating costs and enhanced profitability.

PCS' healthcare experts have developed an APC coding and documentation review to identify and correct coding and compliance errors. The review combines the extensive knowledge of PCS' professionally credentialed coders with powerful analytical tools including our proprietary screening program.

With a comprehensive set of proprietary edits, and a team of personnel continuously dedicated to staying on top of coding policy and federal regulations, PCS has the right solution for you.

Inpatient Coding Review

Most hospitals have both opportunities for improvement and areas of exposure in reporting Inpatient services. Provider Consulting Solutions uses its proprietary Inpatient analytic tools to identify potential ICD-9 coding and compliance issues affecting DRG assignment and hospital reimbursement. Through a detailed coding review, issues related to coding, documentation, discharge disposition or service utilization can be addressed. Together, a roadmap to resolution can be deployed.

PCS reviewers will:

• Analyze select medical records for coding and billing accuracy;
• Evaluate Inpatient coding accuracy;
• Provide training on specific ICD-9 coding issues;
• Evaluate physician documentation quality;
• Develop education forums with Physicians and HIM personnel as appropriate using a proven, successful model;
• Review disposition practices and policy as necessary;
• Review the impact of a changing reimbursement methodology for transfers (Medicare);
• Identify hospital trends and patterns;
• Summarize relevant CMI and service utilization;
• Model hospital data against statewide norms, including, but not limited to, DRG assignment, Acute LOS, Secondary CC Diagnoses

With a comprehensive set of proprietary edits, and a team of personnel continuously dedicated to staying on top of coding policy and federal regulations, PCS has the right solution for you.

Departmental Coding Review

Departmental Focused Reviews specifically target areas of interest and concern. PCS respects the nuances associated with different departments and will focus appropriately to find the right solutions for you, including but not limited to:

• Women's Health
• Pharmacy
• Interventional Radiology
• Emergency Department
• Observation
• Rehabilitation Services
• HIV/AIDS Clinic Services
• Laboratory