Healthcare Revenue Cycle Management - ICD Coding and Audit Process

Phyiatric certified coders (CPC) to ensure to follow the CMS (Medicare and Medicaid) guidelines, Health Insurance, and Client guidelines to bill the claims from the received billing forms as received from clients. Our well-experienced coders will convert the Symptoms written by the provider to ICD coding by using the coding guidelines and coding software. Every coding form will go through the review process to ensure the proper coding is made before hands off to the billing department.

The Phyiatric team has good working and knowledgeable delivery experience in Healthcare ICD-10 coding with valid certification. Our services in ICD-10, but are not limited to, (Healthcare Revenue Cycle Management Services).

• In & Out Patient
• Internal Medicine
• Acute Care
• Skilled Nursing Facility Admit & Discharge
• OBGYN
• Pediatrics
• Hospice Discharge
• Surgeries & DME
• Orthopaedic
• Chest Medicine (Pulmonology)
• Pathology - Cytopathology
• Ophthalmology
• Multispecialty
• E/M
• Mental Health (Psychiatric)
• Physical Health and Behavioral Health (PH & BH - Therapies) 

ICD-10 Coding and Audit Process:

ICD-10 Coding:

Introduction: ICD-10 (International Classification of Diseases, 10th Revision) is a coding system used by healthcare providers to classify and code all diagnoses, symptoms, and procedures. Accurate ICD-10 coding is essential for proper billing, reimbursement, and data analysis.

ICD-10 Coding Process:

Patient Encounter:

• Documentation: During the patient visit, the healthcare provider documents the patient's symptoms, diagnoses, and any procedures performed.
• Detailed Records: Detailed and thorough documentation is crucial for accurate coding.

Code Selection:

• Review Documentation: The medical coder reviews the provider's documentation to identify relevant information.
• Code Lookup: Using coding manuals or software, the coder finds the appropriate ICD-10 codes that match the documented diagnoses and procedures.
• Specificity: The coder selects the most specific codes available to accurately describe the patient's condition and the services provided.

Code Assignment:

• Assign Codes: The coder assigns the selected ICD-10 codes to the patient's medical record.
• Double-check: Coders often double-check their work to ensure accuracy and completeness.

ICD-10 Audit Process:

Introduction: An ICD-10 audit is a systematic review of coding practices and medical records to ensure compliance with coding guidelines and accuracy in billing.

ICD-10 Audit Process:

Audit Services We Provide:

• Skilled and Certified Professional Coders
• Expert Auditors Specializing in CMS Compliance
• Detailed Audit Reports with Comprehensive Status Analysis
• Thorough Documentation Assessments
• In-Depth Medical Record Auditing
• Updates to Fee Schedules and Encounters
• Revenue Growth Projections Based on Audit Insights

Planning the Audit:

• Define Objectives: Establish the objectives and scope of the audit, including which records will be reviewed and what criteria will be used.
• Select Sample: Choose a representative sample of medical records and claims for the audit.

Review Medical Records:

Documentation Review: Examine the medical records to ensure they contain adequate documentation to support the assigned ICD-10       codes.

Consistency Check: Check for consistency between the documentation and the codes assigned.

Code Accuracy:

• Validate Codes: Compare the assigned ICD-10       codes with the documentation to ensure they are accurate and specific.
• Identify Errors: Identify any errors, such as incorrect codes, insufficient specificity, or missing codes.

Compliance Check:

• Coding Guidelines: Ensure that coding practices comply with ICD-10 guidelines, payer-specific requirements, and regulatory standards.
• Up-to-date Codes: Verify that the codes used are the most current and accurate versions.

Report Findings:

• Detailed Report: Prepare a detailed report outlining the findings of the audit, including any coding errors or inconsistencies.
• Recommendations: Provide recommendations for corrective actions and improvements in coding practices.

Implement Corrective Actions:

• Training: Offer training and education to coders and providers to address identified issues and improve coding accuracy.
• Process Improvement: Implement changes to coding processes and documentation practices based on audit findings.

Follow-Up:

• Re-Audit: Conduct follow-up audits to ensure that corrective actions have been implemented and that coding accuracy has improved.
• Continuous Monitoring: Establish ongoing monitoring and regular audits to maintain high standards of coding accuracy and compliance.

Benefits of ICD-10 Audits:

• Improved Accuracy: Ensures accurate coding, which leads to correct billing and reimbursement.
• Compliance: Helps maintain compliance with regulatory standards and payer requirements.
• Financial Integrity: Reduces the risk of denied claims and financial penalties due to coding errors.
• Data Quality: Enhances the data quality used for clinical research, reporting, and decision-making.

Summary:

Accurate ICD-10 coding and regular audits are essential for healthcare providers to ensure proper billing, reimbursement, and compliance with regulatory standards. By implementing thorough coding practices and conducting systematic audits, healthcare organizations can improve their financial performance, reduce the risk of errors, and maintain high data integrity standards.

Partner with Us for Expert ICD-10 Coding and Audit Services

At Phyiatric, we specialize in providing comprehensive ICD-10 coding and audit services to healthcare providers. Our team of certified coders and auditors ensures accuracy, compliance, and financial integrity. Contact us today to learn how we can support your organization with our expert services.

Contact Information:

• Phone: +1-804-245-5583
• Email: admin@phyiatric.com / phyiatric@outlook.com