Why is the Medical Coding Audit Function More Important Than Ever?

Medical Coding Audits More Important Than Ever

It’s all about Clinical Documentation Improvement (CDI).

With the recent implementation of ICD-10, Nearterm believes that coding audit practices are now a critical part of what healthcare organizations must do to remain compliant and sustain healthy cash flow.

Briefly, medical coding audits seek findings that support CDI implementation and ongoing CDI practices.  The audit process also reveals root causes of coding errors that can increase denials and put pressure on revenues. And there is more.

What Comprises Medical Coding Audit and How Does It Translate To Both Short Term and Long Term Benefit?

 Nearterm Medical Coding Auditors and CDI experts can provide the following range of services (and more) based on client needs:

  • Performs concurrent ICD-10 coding analysis of medical records and provider claims to validate code assignment
  • Reviews physician and provider documentation for high quality clinical documentation, based using evidence-based clinical criteria that translates into and supports accurate diagnostic and procedural coding
  • Applies official guidelines for coding and reporting consistently and appropriately
  • Provides written explanations to support or rebut coding recommendations
  • Develops and presents educational material for coding professionals
  • Serves as a coding resource for Health Information Management (HIM), Quality Assurance, Utilization Review, and Patient Accounting Department
  • Provides support for training new and experienced coding staff
  • Supports developing and presenting clinical documentation improvement program education for physicians

What does it take to be a Nearterm Medical Coding Auditor?

Nearterm has high standards. That said, our experienced Medical Coding Auditors and CDI experts typically have the following background and skills:

  • RHIA, RHIT, or CCS credentials
  • 5 or more years of medical coding experience
  • ICD-10 training
  • Excellent knowledge of Official Guidelines for Coding and Reporting as well as AHA Coding Clinics to support audit findings
  • Outstanding computer skills
  • Excellent written communication skills
  • Ability to efficiently review large volumes of documents with high comprehension level
  • Secure home office environment, compliant with HIPAA requirements if working remotely

As an HIM Managed Services Provider, Nearterm can provide clients with Medical Coding Audit and CDI services as part of a 360 Managed RCM Services solution.

As a “Managed Service Provider,” our staff are professionally managed and their performance is measured by a Nearterm Partner in Charge (PIC). This is to ensure they meet the service level quality requirements agreed upon with the client, as expressed in our Q100=Quality Assurance program.

Got any questions?

Ask the RCM Experts

Posted By: nearterm-admin

Nearterm Managed RCM Project Staffing Services

Managed Revenue Cycle (RCM) Project Staffing

A billing or coding backlog that challenges your manpower resources can put your cash flow at risk.

Nearterm can rapidly deploy a professionally managed team of qualified technicians to eliminate backlogs or to backfill a special HIM or Revenue Cycle project.

The team can be dedicated to a specific functional area (e.g. Medical Coding, Medicare Collections, Billing, etc.) or distributed across multiple functional areas (e.g. medical coding, auditing and/or accounts receivable) depending on your needs. Either way, the team can work on-site and/or remotely. And they are always professionally project managed by a Nearterm Partner in Charge (PIC). (See more below.)

When you need experienced Healthcare Revenue Cycle Consulting, or Project Staffing Services and RCM Project Management, contact Nearterm online, or call us toll free at 888-646-1330 or click:

 How RCM Project Staffing Works

One of our staffing professionals works with you to establish skill-set, scope of work, project details, staffing requirements, schedule and other related matters.

All Nearterm needs is a brief orientation to your systems and procedural requirements (for coding or AR) prior to the commencement of production work. For remote work, Nearterm will work with you to establish remote connectivity with your systems. Our professionals will use your system like an onsite hospital employee would, always in compliance with HIPPA. Many hospitals have taken advantage of this cost effective model.

We assemble the resources you need and arrange for them to be there when you need them, on-site or remote

Healthcare AR Resolution Specialists Project Services

Our managed AR Specialists project team consists of experienced AR Technicians, Billers, Collectors and other Back Office professionals who are proficient with your system and have a clear understanding of Medicare and Medicaid processing requirements as well as those of most commercial payors.

See also Nearterm RCM AR Resolution Specialists PDF or

What Do Accounts Receivable Specialists do in a Healthcare Organization?

Medical Coding & Auditing Project Services

For HIM/Medical Coding and Medical Code Auditing, Nearterm offers credentialed Medical Coders proficient in your systems. For the different types of Medical Coders available, see: Certified HIM/Medical Coders: Remote or On-Site PDF

As a Managed Revenue Cycle Project Staffing Services Provider, Nearterm can provide clients with 360° RCM Services solutions.

As a “Managed Service,” our Project Specialists are professionally managed and their performance is measured and managed a Nearterm Partner in Charge (PIC). This is to ensure that they meet the service level quality requirements agreed upon with the client, as expressed in our Q100=Quality Assurance Program.

Q100=Quality Assurance
For our RCM Project Staffing Services & Management

At the beginning of every new engagement, performance quality standards are defined in close collaboration with our client. The goal of Q100 is to provide an ongoing quality definition and measurement methodology in a format that enables us to confirm that we are meeting the high standards our clients have come to expect. Our Partners are recognized authorities in Revenue Cycle Management. To learn more, download  our Q100=Quality Assurance PDF.

.Ask the RCM Experts



Posted By: nearterm-admin

Improving Cash Flow

HFMA Gulf Coast Image 2

Check out this great article written by our very own Jim Matthews for the HFMA Gulf Coast Express – February 2016 Newsletter:  http://files.ctctcdn.com/d6aa2798201/aedf162e-cc2f-46a7-ab9b-c49a1b0708bc.pdf

Improving Cash Flow

Cash flow from patient care revenue is one of the CFO’s main concerns in today’s transitioning industry environment. How can hospitals and healthcare provider organizations develop sustainable and growing cash flow in this new world?

At Nearterm, we believe that the cash flow challenge to hospitals and healthcare facilities today is to build a sound revenue cycle management (RCM) process that balances a quality consumer-patient clinical experience with an improved financial experience. Doing that produces a sustainable and growing cash flow.

How do we get this balance?

It is critical is to get the patient’s financial experience in-line with the patient’s clinical experience, from the front office to the back office. To do this, our customers are integrating new RCM software with the hospital’s clinical and coding systems to mirror and follow patient care cycle, from front to back office.

What should happen in the front office?

Today, given the complexity of healthcare financing, an important component of the front office patient access is financial options counseling. Here, the patient is advised of the anticipated costs and a payment solution such as verification of coverage, insurance or self-pay is determined.

Most patient-access situations will be routine, but others may require a custom solution. The custom cases are the exceptions and they typically need more time and more experienced professionals to handle them.

The better the front office is at what it does, the easier it is for the back office.

What should happen in the back office?

With the new RCM software integrated with the hospital clinical and coding systems, the back office can track the claims process at every point of the clinical experience. This allows the back office to follow the process and address any issues to prevent a claim denial after the patient is discharged. The goal is to have the patient leave with a positive financial experience when discharged.

There will be exceptions such as denials and non-payment. Then the goal becomes account resolution and determining how to prevent such instances in the future.

How does Nearterm help their clients with RCM?

Nearterm is very flexible in how we engage with clients, providing a custom mix of:

  • Interim Management
  • RCM Consulting
  • HIM/Medical Coders (On-site or Remote)
  • AR Resolution Specialists (On-site or Remote)
  • Healthcare Executive Search
  • RCM Project Staffing
  • Co-sourcing

Co-sourcing is an interesting new way of looking at how we work with customers.

Clients can co-source the exceptions mentioned previously that occur in the back and front offices. We offer experienced Patient Access and AR Resolutions Specialists as well as HIM/Medical Coders who can work on-site or remotely.

In addition, our RCM interim management professionals can manage RCM process improvements to reduce exceptions and improve patient account resolutions.

We find that the better a client gets at RCM, the more payors will favor them and that in itself can generate more business and more cash flow.

Want to hear more, give us a call at 888-646-1330

Posted By: nearterm-admin