Coding, Billing and Documentation Compliance
As government continues to expand its regulatory enforcement activities both at the state and federal level, providers are forced to refocus their resources to manage the data collection and auditing processes. Recoupment has become a favored means for the government to replenish its coffers. Enforcement programs such as Recovery Audit Program (RAC) and Medicaid Fraud Control Units can place enormous operational challenges on providers with or without robust compliance programs.
FTI Consulting is here to assist you with managing these challenges. Our highly experienced and credentialed coding professionals have proven experience addressing complex coding, billing and documentation issues. There is no substitute for subject matter, hands-on experience.
Key Services Areas
A representative listing of the types of services we offer is as follows:
- Inpatient MS-DRG coding and billing audits
- Outpatient hospital coding and billing including charge description master reviews, charge capture processes, and coding
- Physician professional coding and billing audits including “incident to” and “shared-split” services
- Investigations into billing compliance issues
- Audit support for providers involved in litigation such as qui tam
- External compliance auditing
- ICD-10 and ICD-10-PCS training and education
- Physician at Teaching Hospital audits
- Hierarchical condition code assignment review for Medicare Advantage programs
- RAC operational and appeal assistance
- Independent Review Organization services to fulfil obligations outlined in settlement agreements.
- Revenue cycle compliance assessments
- Due diligence associated with health care mergers, acquisitions, or other transactions
- Training and education to providers related to proper coding and documentation