Coding & Documentation

In an environment of constant reimbursement rule changes  and an ever expanding array of medical codes, having access to knowledgeable and experienced medical coding professionals is critical for the sustainability and growth of your organization. BCS’s team of experienced Coding and Compliance professionals is committed to providing our clients with the finest medical record coding support available. BCS provides fully compliant coding that ensures optimal reimbursement and boasts industry leading turnaround times and coding accuracy.   Our primary goal is to give your practice the tools that you need to: continually improve the level of service provided to your patients; enhance operational efficiency and profitability; and enable sustainable growth.

BCS offers the following services to help take your practice to the next level:

Coding & Documentation Review

Coding & Documentation Review

To ensure full and accurate reimbursement for healthcare services rendered by your practice, coding should always be driven by well documented patient care. Unfortunately, it is all too common for pertinent clinical information to be absent from a patient’s chart. While incomplete documentation has always put physician practices at financial risk, it is becoming an increasing concern due to the implementation of accountable care, pay-for-performance, ICD-10, and value-based purchasing initiatives.

Monitoring your practice’s compliance with established and impending coding and documentation standards is a critical activity to protect your organization from financial risk. Engaging an external party to perform a medical record review can help your practice to identify documentation omissions that could be resulting in inappropriate payments and denials as well as adversely impacting patient care, physician profiling, and medical research activities.

BCS’s professional team of certified coding and compliance consultants have extensive experience performing independent coding reviews in both the inpatient and outpatient settings. Our Medical Record Chart Reviews are performed in compliance with AMA, CMS, and insurance carrier coding guidelines and comply with both HIPAA and the National Correct Coding Initiative. As such, BCS Medical Record Chart Reviews typically evaluate the accuracy of procedure and diagnosis coding, modifier usage, completeness of documentation, medical necessity, potential lost revenue, and charge-based opportunities.

Appropriate documentation is the practitioners’ best defense against a carrier audit. Let BCS help you identify and reduce your coding and documentation risks.

Clinical Documentation Improvement (CDI)

Clinical Documentation Improvement (CDI)

BCS’s Clinical Documentation Improvement solution significantly improves clinical documentation, ensuring that it fully and accurately reflects the severity of illness, complexity of care, and resources consumed. Our comprehensive program bridges the gap between clinicians and the coding and billing system; increasing and capturing appropriate reimbursement for services provided. BCS can provide the tools, strategies, and skills necessary for you to achieve the most accurate documentation and coding.

Our Clinical Documentation Improvement team is composed of certified Coding & Credentialed Clinical Documentation Improvement Professionals along with utilization review nurses. The BCS team brings more than 30 years of collective experience to every engagement.

Coding Support

Coding Support

BCS provides medical coding services to physician practices across most specialties. We employ credentialed and experienced coders to address your medical coding needs. The BCS team delivers fast and compliant coding services and always back up our advice with source documentation so you can be assured that our advice is accurate and is defensible. BCS can provide you and your organization with coding support on a per question, interim, or long-term (partnership) basis.

Interim Coding Assistance

Unexpected things happen. Backlogs occur.

BCS can provide your organization with interim coding or coding management services when you need them the most. All of our coders are certified and have multiple years of experience to serve our clients’ needs.

Subscription Coding Support

Coding questions and claim issues are unavoidable. Having a reliable source for your coding questions will save you time and effort. When they come up, let BCS be your “go to” source for answers.

BCS can provide you and your organization with coding support on a per question to an unlimited basis. We always back up our advice with source documentation so you can be assured the advice we provide is accurate and is defensible.

Corporate Integrity / Independent Review Organization

Corporate Integrity / Independent Review Organization

Healthcare organizations that enter into a Corporate Integrity Agreement (CIA) with the government are required to retain an Independent Review Organization (IRO). Depending on the details of the CIA, the IRO’s responsibilities can range from performing a verification review to an extensive review of the organization’s processes for compiling and submitting claims, including coding and medical necessity. In most cases, the IRO will be required to audit a sample of the claims the organization is submitting to Federal healthcare programs.

For organizations entering into a CIA, selection of an IRO can be a difficult and confusing event. With deep expertise in healthcare compliance and years of experience in providing IRO services for medical practices, hospitals, and institutional providers, BCS’s consultants are uniquely qualified to function as your IRO. BCS has a team of highly qualified and highly experienced professionals who will work with your organization to: insure that your staff is prepared for the IRO audit; answer your questions throughout the process; fulfill the requirements of a CIA; and set you on the path to on-going compliance.

Select BCS as your IRO and let us help you meet the requirements of your CIA.

Claims Appeals Assistance

Claims Appeals Assistance

From time to time, an insurance carrier may deny an individual or series of claims or ask for money back for services previously rendered to your patients. Just because the carrier has denied a claim or asked for a recovery payment doesn’t mean this request is appropriate or based on accurate information.

When your practice is facing denials and recovery payment requests, BCS’s coding and compliance experts can help you review documentation for correct coding, compliance, and claim reporting and guide you through the entire claims appeal process.

Let BCS help ensure that your practice is not unduly burdened by inappropriate denials and recovery requests.

Recovery Audit Contractors & Medicaid Audit Contractor Appeals

Recovery Audit Contractors & Medicaid Audit Contractor Appeals

The Recovery Audit and Medicaid Integrity Contractors (RACs and MICs respectively) are placing an increasing proportion of physician practice revenue under scrutiny. Appealing denied Medicare claims has always been a challenge, but now, more than ever, your practice must work diligently to retain your reimbursements.

Organizations facing denied claims must appeal the denials in a timely and coordinated manner with the right documentation and, often times, with third party support. Effectively managing the appeals process and tracking submitted appeals are effective strategies for holding on to the reimbursement you deserve. A fundamental understanding of how RACs or MICs are impacting the process as well as the five levels of the appeals process (i.e. redetermination, reconsideration, Administrative Law Judge Hearing, Medicare Appeals Council Review, and Federal District Court Review) can significantly increase your ability to successfully appeal overturned claims.

Is your organization in the best position to fight a denied Medicare or Medicaid claim?

If not, let BCS guide your practice through the five levels of appeal.