Coding and Compliance Audit Services

Healthcare organizations must maintain a commitment to ethical, comprehensive, accurate, and consistent HIM coding and documentation improvement. Maintaining the integrity of coded data and revenue accuracy requires consistent application of the official coding guidelines, rules, and conventions. Healthcare fraud and abuse has become a top priority for the federal government.

Services

Hospital Inpatient MS-DRG/Outpatient APC Coding Quality Assessments

  • Comprehensive and Focused Compliance Assessments
  • Independent Review Organization (IRO) Services
  • Quarterly Compliance Assessments
  • MS-DRG Validation
  • Clinical Documentation Improvement Assessments
  • Training and Education

Value-Based Purchasing (VBP) Assessments

  • Patient Safety Indicators (PSI)
    • Confirm “inclusion” criteria diagnosis or procedure codes for proper assignment in the PSI measure calculation
    • Review for “exclusions,” such as diagnosis and procedure codes, admission type, and discharge disposition, all of which trigger an included discharge to be excluded from the PSI measure calculation
  • Hospital-Acquired Condition (HAC)/Hospital-Acquired Infection (HAI)
    • Validate the present-on-admission (POA) status indicator
  • 30-Day Readmission/30-Day Mortality
    • Verify the principal diagnosis for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD)/respiratory failure, heart failure, pneumonia/sepsis, stroke
    • Review for additional comorbidity risk-adjustment variables
  • Training and Education

E/M AND PHYSICIAN SERVICES CODING & DOCUMENTATION REVIEWS

  • Routine and Focused Coding & Documentation reviews
  • Statistically significant sampling/extrapolations
  • Appeal Support
  • Provider/internal coder dispute resolution
  • Pre-acquisition due diligence
  • Training and Education

Experience

PYA offers compliance advisory services that include hospital inpatient and outpatient coding and compliance services as described below. Our team of experienced professionals understands the documentation and coding challenges organizations face to achieve healthcare compliance. Our expertise is reflected by the following certifications and credentials:

  • Registered Health Information Administrator (RHIA)
  • Registered Nurse (RN)
  • Certified Coding Specialist (CCS)
  • Certified Outpatient Coder (COC)
  • AHIMA-Approved ICD-10-CM/PCS Trainer
  • Certified Professional in Healthcare Quality (CPHQ)

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