Overview
Our client is a comprehensive healthcare facility providing a wide range of inpatient and outpatient services, ranging from emergency medicine and cardiology, to pediatrics and rehabilitation.
After experiencing challenges with coding and billing accuracy rates, coding denials, and revenue leakage, our client approached CodingAID to develop a robust, long-term Provider Education Program (PEP) to strengthen its coding operations. To help our client achieve its operational goals, CodingAID conducted targeted audits and implemented structured post-audit provider education.
Our Approach & Scope
CodingAID worked with our client to develop a 3-Phase Provider Education Program (PEP) to support its providers and provide ongoing training and education during a multi-year partnership.
Phase 1
Audit: Initial/Kickoff | Review: Codes | Education: Mandatory
- Comprehensive review of all codes and cases selected by the providers
- Audits performed on the codes submitted, compared to documentation
- Mandatory post-audit training on the new E/M Guidelines
- Repeat audits and education sessions post-training
Phase 2
Audit: Cadenced | Review: Workflow & Template | Education: Customized
- Regular cadence of ongoing audits of provider cases
- 1:1 training sessions to review audit findings, including re-reviews
- Department-based reviews to identify workflow and template issues for revision
- Annual coding guideline education conducted
- Post-education, providers with less than 90% accurate coding were re-audited
Phase 3
Audit: Specialty-Specific | Review: Ongoing | Education: Ongoing
- Ongoing annual audits and coding guideline education, plus 1:1 reviews
- Audit focus shifted to Outpatient, Professional Hospital, Surgeries, and more
- Separate coding team developed to assist with the production coding work
- Created a compliant provider tasking process, using EMR messaging automation
Coding Operations Transformed
Before Partnership: Before its partnership with CodingAID, our client was routinely out of compliance, experienced ongoing revenue leakage and coding denials, and struggled with documentation and coding accuracy rates across major code categories.
After Partnership: After the successful implementation of its Provider Education Program (PEP), our client experienced reduced coding denials, increased revenue, and improved internal process for sustained operational efficiency. Our client reduced risk of audit from OIG and other governing bodies, and improved coding accuracy rates.
Coding Accuracy Rates
CodingAID’s experienced Provider Audit & Education team transformed our client’s coding practices by conducting targeted audits and performing tailored education to fill operational gaps.
CodingAID’s customized education and training program resulted in significant improvement across all major code categories: E/M, ICD-10, and CPT/HCPCS.
Conclusion
By partnering with CodingAID to perform a Provider Audit and develop a long-term Provider Education Program (PEP) across a multi-year partnership, our client transformed its coding operations, strengthened compliance, and significantly improved documentation and coding accuracy rates.
CodingAID implemented a custom, 3-phase Provider Education Program (PEP), consisting of a multiple audits and reviews, and tailored education modules to help our client prevent future coding denials, recover missing revenue, and achieve ongoing operational compliance.
Resources
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