Coding Compliance Reviews - Outpatient Audit - Full APC Audit
A structured coding and billing validation audit program performed by an external, unbiased third party.
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A structured coding and billing validation audit program performed by an external, unbiased third party will assist your organization’s ongoing efforts to maintain compliance with regulatory requirements, identify and correct errors that may reduce revenue, and prepare for the escalating levels of external scrutiny imposed by government regulators.
Healthcare Cost Solutions (HCS) provides various types of coding validation audit services, performed by credentialed HIM professionals experienced in coding and reimbursement compliance. Our on-site and remote coding validation audit services assist organizations in identifying and correcting occurrences of coding non-compliance that result in either “over-coding” or “under-coding.”
An Exit Conference educational session is conducted with the coding staff at the conclusion of every audit. Continuing education units (CEUs) from AHIMA are awarded to all staff in attendance. Recommendations for coding changes are supported by authoritative, official coding and billing references. A detailed and comprehensive summary report is provided that includes documentation of all findings and identification of patterns and trends that can be used for internal communication and administrative discussion.
Outpatient Audit - Full APC Audit
A Full APC audit includes a review of all procedures assigned on the UB and the patient’s bill. Reviewing observation, outpatient surgery, clinic and /or emergency room records will ensure compliance with CPT and HCPCS procedure codes, corresponding APCs, and ICD-10-CM diagnoses. The reviews typically cover codes assigned by HIM personnel and codes charged through the organization’s Charge Description Master (CDM). Surgical codes, evaluation and management (E&M) level assignment, drug administration charges, imaging, and separately payable pharmacy charges are all validated, in addition to validation of the ICD-10-CM diagnosis codes to calculate correct APC reimbursement.
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Why Trust Coker
For more than three decades, Coker has been a trusted partner to healthcare leaders and investors, delivering clarity, compliance, and confidence through every stage of the transaction and beyond.
Positive outcomes are possible for you and your patients.
We approach every engagement with a results-driven mindset, leveraging our deep industry expertise and data-driven insights to develop strategies that drive meaningful, measurable improvements in performance.
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Solutions We Offer
We partner with clients to navigate the dynamic challenges of managing a high-performing physician enterprise.