Accuracy of medical coding, both ICD-10-CM and CPT/HCPCS coding, has never been more important to the health care companies as it is today. Auditors across the spectrum of payers examine claims for appropriate diagnostic and procedure codes to determine if a claim is properly paid. Payer investigations lead to overpayments, civil monetary penalties and sometimes a finding of fraud or abuse. Correct coding can often prevent such outcomes. That’s why providers need to consider outsourcing coding to professionals who can provide competent coding AND provide guidance to the providers on how to support the coding in clinical documentation.
The MJS coding professional staff is led by Registered Nurses, including ICD10 certified coders. We believe that registered nurses can contribute more to the providers than ancillary coding staff which is commonly used by some coding companies. MJS also employs certified CPT/HCPCS coders in the billing department who are supervised by a Registered Nurse. Again, it is the opinion of MJS that coding functionality cannot be simply the selection of an appropriate code; it must include the adequacy of the supporting documentation so that the requirements of the selected code.
MJS reviews applicable documentation before recommending ICD10 primary and other diagnoses. This includes reviewing hospital/ facility records, physician encounters and orders, laboratory results, medications and other pertinent medical records. Diagnosis codes are sequenced according to the applicability to the care to be rendered in accordance with applicable coding guidelines.
CPT/HCPCS codes are often entered by the practice’s staff and/or physician during the encounter. These may appear on a superbill or comparable when MJS performs the billing. Or, if the practice wishes to have coding confirmation, MJS can review a sample of documentation and recommend ways to improve documentation to better meet the code requirements.
In all coding situations, MJS can provide initial training to your internal staff or perform follow-up review of coding independent of any outside review by the payers. Or, if requests for medical records raises the issue of possible coding errors, MJS coding experts can work with the provider to establish a best case response.
MJS offers a variety of services to support the home health agency’s RCD choice. This applies to Texas providers only at the present time. The MJS RNs perform the following services:
The MJS Audit Team provides independent review of documentation when claims have been denied or when documentation is requested in advance of claim adjudication or in a targeted sample record request. We work diligently to get the claim paid or reversed if a denial has been given. If, however, the claim is denied, the MJS team provides review and support at all levels of appeal including at the Administrative Law Judge hearing level.