Question: Why should I choose CodeArc as our preferred vendor for coding/auditing outsourcing?
Answer: We assign an exclusive team of skilled coders, auditors and a QA manager for each of our client’s needs at a competitive price. Our ongoing intensive coding educational support helps our team in touch with ever changing healthcare rules.
Question: Are you HIPAA compliant?
Answer: Yes, we operate in a sterile HIPAA environment. We keep track of all new code and regulatory changes and, keep ourselves updated and in compliance at all times. Confidentiality and security of your records are maintained through encryption technology and strict operating procedures.
Question: What medical specialities do you code?
Answer: We code Inpatient stays, Outpatient stays, Same Day Surgery, Emergency Department, Long term care, Home Health, HCC, HEDIS and Physician groups of all specialities and sub specialities.
Question: Why are medical audits performed?
Answer: Medical audits are typically performed to uncover inaccuracies before insurance or government payers discover them and request that an internal audit be conducted. When a payer challenges a coding claim the discrepancy must be identified and correct before it can be resubmitted and this delays reimbursement. However, a medical audit can also be conducted in order to prevent the occurrence of fraudulent claims or duplicitous billing procedures.
Question: What are the responsibilities of CodeArc’s medical auditor?
Answer: A medical auditor focuses on maximizing coding and billing proficiency as well as patient care quality through auditing procedures that help companies identify their weaknesses and strengths. This ensures that potential coding inconsistencies can be resolved before the claims are sent to insurance payers.
Question: What is underbilling?
Answer: Underbilling refers to persistently coding services inaccurately. This includes failing to receive payment for a service that was never coded or billed, or coding a service incorrectly, thereby causing the amount of reimbursements to be too low. In such cases, a medical audit is a key process that can help companies resubmit claims before the reimbursement deadline.
Question: What is overbilling?
Answer: Overbilling is another form of inaccurate coding. This may be in the form of duplicate coding in which the same service is coded twice. Upcoding may also occur and refers to assigning a service a more expensive code. Frequent medical audits can disclose this issue before the charges become liabilities and are deemed as fraudulent.
