Optimize Revenue and Reduce Risk with Medical Coding Services and Healthcare Regulatory Compliance Services
For hospitals, physician practices and other providers, two objectives matter most when it comes to billing for clinical services: maximizing revenues and reducing regulatory risk. Faced with an increasingly complex regulatory environment and aggressive federal and state audit initiatives, medical billing and coding operations at hospitals and physician practices must comply with all applicable healthcare laws and regulations.
Additionally, lost revenue from poor medical coding practices can significantly impact financial performance. And now with ICD-10 coding firmly in place, the industry is experiencing some troubling healthcare reimbursement trends: payer system inaccuracies, denials due to unspecified codes and other non-standard submissions, an increase in medical necessity denials, slower payments, and underpayments – all of which put healthcare organizations at risk.
The solution is a full-time, hands-on healthcare coding and regulatory compliance program. The program should include both the review, monitor and tracking of each medical claim and the identification of disconnects that bring errors to the payers’ attention and/or identify where further education and assessments are needed to improve performance across the organization.
McKesson Coding and Compliance Services can help your organization more effectively manage denials, increase payment velocity and transition to value-based care, all with experienced coders who exceed industry standards of excellence.
Complete Medical Coding Services
From full outsourcing to episodic project work, our coding services address both sides of coding by identifying missed revenue opportunities as well as potential compliance risks due to inaccurate coding.
- Coding Services for Any Care Setting, Any Duration: We can help you improve accuracy with ongoing, periodic or one-time coding assistance across all medical specialties, care settings or with hospital charge capture assessments.
- Clinical Documentation Assessments: We can conduct periodic audits of your internal operations by department and by provider to provide a check on coding and documentation processes and performance.
- Physician and Back Office Staff Training and Education: We can provide on-site or virtual training to address coding and documentation processes deficiencies. Our clinical documentation improvement programs, physician education sessions and medical records services will help position your staff to document more effectively, code more accurately and, in turn, receive the reimbursements you are due for services rendered.
- ICD-10 Deep Domain Expertise: Our coders successfully managed the transition to the ICD-10 code sets for our customers and remain committed to monitoring ongoing code additions.
Healthcare Regulatory Compliance Services
McKesson Medical Coding and Compliance Services offers, in addition to coding management, an additional oversight function to your organization for providing information and guidance on applicable federal and state statutes, regulations, and other payer requirements. Some compliance services are available to healthcare organizations with their own medical billing coding teams.
- Healthcare Compliance Plan Assessments: For organizations with their own coding teams, we can evaluate your coding and documentation compliance procedures, using federal and state requirements as our guides. The evaluation will be integral as you shift your team’s focus to delivering value-based care.
- Compliance Plan Development and Monitoring: We can help your team establish best-practice coding and documentation compliance standards as well as processes for auditing and confidential reporting, including enforcement, response and prevention guidelines.
- Specialty-specific Auditing: We can review and evaluate the groups/individuals responsible for monitoring, tracking and reporting charges to identify deficiencies in code and modifier assignments as well as opportunities for improvement.
- Provider Education Services: McKesson’s provider education services are designed to optimize front-end and back-end billing processes. These services, which are offered on an annual and ad hoc basis as necessary, include:
- Provider documentation training
- Annual CPT and ICD-10 coding updates/changes
- National coverage determination and local coverage determination update for CPT/ICD-10 coding acceptance
- Updates on regulatory guidance affecting coding/documentation (e.g., Quality Payment Program, IDTF policy changes, Stark Law, etc.)
The Strength of McKesson Coders
Correct coding for your services requires well-trained and experienced specialty-specific medical coders and coding management. McKesson currently has more than 600 specialty-specific, certified coders, who receive more than 30,000 hours of compliance training annually.
- Specialty Coding Certification: To address the nuances of specialty-specific coding, McKesson developed Specialty Coding Certifications (SCCs). Following intensive training, coders must pass the SCC exam and accurately code selected charts with the correct CPT, modifier and ICD-10 codes for both facility and non-facility charts.
- Certified Leadership: All employees issuing coding guidance internally or externally, including coding managers, supervisors and team leads, are also nationally certified as a Certified Professional Coder (CPC) or CPC-Hospital (CPC-H) and work one-on-one with their coding staff.
- Superstars: McKesson coders demonstrate minimum accuracy levels of 95%. Historically, claims coded by us have resulted in internal audit adjustments of less than 1% due to an auditor’s requirements.
Staying True to the Mission
Our compliance efforts are designed to establish a culture that promotes prevention, detection and resolution of conduct that conforms to federal and state law, and federal, state, and private payer healthcare program requirements, as well as McKesson’s own ethical and business policies.
- Quarterly Quality Assurance Audits: All production coders undergo a quarterly coding quality assurance (QA) audit in their specialty-specific area. Approximately 65,000+ items are reviewed as part of the quarterly coding QA process. Coding performance is measured based on quality of work and resolution rates. Our efforts to improve never stop.
- Annual External Audit: To affirm that McKesson’s oversight and direction are objective and in agreement with industry standards, each year an external auditing firm reviews a sample of the claims that McKesson has audited.
- Confidential Reporting: McKesson maintains an anonymous compliance hotline through an external vendor for employees to report concerns about compliance issues in a confidential manner and without fear of retribution. Issues reported via the hotline are thoroughly investigated and corrective action is taken when necessary.