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Medical Coding

Medical coding is becoming increasingly challenging. Technology is changing, and coders are expected to stay on top of new coding standards. That is what we at Total RCM focus on. Eighty percent of our coders are AAPC Certified and we ensure –

  • Accuracy of ICD-10-CM Diagnosis.
  • Accuracy of CPT/HCPCS Codes and Modifiers Assigned.
  • Claim scrubbing and edit checks.
  • Accurate E/M Level Assignment.
  • Provide Education for Physicians on enhanced Documentation.
  • Denial Management and Analysis.
  • We implement guidelines and policies for team to track trend and educate staff as well as system adjustments to assist in denial reduction and prevention.
  • No Fault and WC documentation.

Compliance Audit:
Compliance audit is conducted to ensure proper codes are billed and adhere to policies andprocedures of healthcare insurance.  For auditing purpose, a fraction of sample encounters
is picked up randomly based on E&M Procedures and surgeries. We focus below areas in our compliance Audit:

  • Review E/M , Procedure and diagnosis usage against State and national Peer Data to verify if a service is Up coded ( Reporting a higher-level service or procedure or a more complex diagnosis, than is supported by medical necessity, medical facts, or the provider’s documentation) or down coded (Down coding occurs because the provider fails to provide relevant documentation details to assign a service, procedure, or diagnosis to the optimal level of specificity).

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