Coding & Compliance
The DOJ and OIG state that healthcare organizations must establish adequate internal procedures to ensure the accuracy of claim submissions to third party payers. Nationwide, facilities’ noncompliance with payers billing requirements result in millions of dollars in over payment needing to be repaid each year. A healthcare organization’s failure to establish compliance procedures can easily turn an honest billing mistake into a false claim that is subject to penalties.
Coding & Compliance Audits
With Lighthouse Healthcare Advisors you get a personal approach to external audits/documentation review. After analyzing your areas of specialty, we select records for review based on your common coding practices. Focusing on CPT and ICD-10 guidelines and usage, we provide professional feedback with formal findings presented by our Coding Education Specialist. Our advisor spends time one-on-one with providers and their teams to ensure proper documentation, coding, and compliance best practices to improve claim denial rates and reimbursements.
We’ll find opportunities for improvement and support you in continuing your correct coding initiatives.
LHA coding and compliance audit services include:
• External Audit/Record Review
• Pre-payment or Post-payment auditing
• Utilization analysis with comparison to local and national peers.
• Focused audit selection
• Medical record documentation review
• ICD-10 code selection review for HCCs
• Annual Assistance: On-Demand Research for all of your coding and compliance inquiries with written reports.
• In-person audit review and education with physicians and staff.
On-Site Coding Education
Medical Coding is complex and updates occur regularly. LHA Coding Education Specialists are AAPC Certified with vast experience in coding, auditing, and compliance training.
LHA will keep you and your team up to date with industry changes with these on-site education services:
• New Provider, Coder and/or Biller documentation and coding education.
• Annual CPT & ICD-10 CM update review sessions
• HIPAA Training
• ICD-10 CM, CPT, & HCPCS Training
• Compliance Seminars
• For complete AAPC CPC Training, check out the LHA CPC Exam Prep Course
Physician Practice CDI Program
Risk adjustment using HCC framework is fundamental to physician reimbursement, patient and population health management, and supporting value-based programs. With Lighthouse Healthcare Advisors you get a customized approach to clinical documentation review and improvement.
We follow a focused, four-step program to improve the accuracy of your patient panel risk score through accurate documentation and coding.
Step 1: Identification of High Risk/High Utilizing Patients utilizing your existing analytics platform or through our proprietary tool.
Step 2: Comprehensive patient chart review resulting in identification of clinical documentation deficiencies and notification of required diagnostic tests.
Step 3: Timely notification linked to next patient visit for appropriate clinical documentation and code specificity.
Step 4: Workflow redesign and practice transformation strategy to promote efficient and accurate documentation which supports accurate diagnosis code assignment.
Due diligence is an essential step when selling, acquiring or merging practices. Protect yourself by performing audits and revenue integrity reviews to fully understand the potential compliance risks and areas of revenue opportunity. Let LHA help with your due diligence efforts by completing comprehensive or partial reviews of entities for potential purchase or employment.
LHA’s due diligence services include:
Comprehensive audit of medical documentation and coding
Report identifying coding and compliance issues
Provide an assessment of revenue integrity
Areas of Focus
• Compliance Planning
• Risk Adjustment
• Clinical Documentation Improvement (CDI)
• Evaluation and Management
• Billing/Coding Rules and Research
• Population Health
• Value-based Models
• Psychiatry and Psychology
• Pain Management
• Physician Practices
• Primary Care
• General Surgery
• Breast Surgery
• CHF Clinics
• Wound Care Clinics
• Infectious Disease
• Home Health
• Urgent Care