Coding, Documentation, Billing, and Compliance Review

    Coding, Documentation, Billing, and Compliance Review

    Most of the data you use in health care decision making (whether strategic, operational, or financial) comes from coding. CPT and HCPCS (currently) define your services, while ICD-9, and ultimately ICD-10, define why you provided those services. Getting it right is important now, but it will be CRUCIAL in driving future reimbursement and even care delivery decisions (e.g., team care issues, managing patient panels).

    Wipfli’s certified consultants are your external resource to assess the accuracy of your coding and determine whether documentation supports the services delivered. Our strength is in drilling down to the key issues and efficiently helping you resolve them, both in the short term and for the long term.

    Areas of Expertise

    Wipfli consultants hold multiple certifications in coding and compliance and are experts in the following coding systems and billing/reimbursement areas:

    • CPT
    • HCPCS
    • ICD-9
    • ICD-10
    • APC
    • CMS-1500 claims
    • RBRVS RVUs
    • UB-92 claims
    • Provider-based, RHC, and FQHC billing

    Types of Services 

    • E/M “bell curve” analyses by physician, department, and organization-wide
    • Chart reviews to compare coding to documentation to identify:
      • Revenue opportunities
      • Compliance exposure
      • Areas for documentation improvement, especially for ICD-10 preparation
    • Coding process review
      • Review efficacy of data capture processes
      • Physician shadowing
      • Coder shadowing/mentoring
    • Physician education for improving documentation – classroom and one-on-one
    • Coder education
      • Coding technique
      • Train the trainer
      • How to mentor physicians
      • Conducting follow-up reviews
    • Staffing function/structure remodeling
    • Ongoing ad hoc coding and billing research
    • Compliance programs
      • Full-scale assessments for clients with existing programs
      • Assistance in developing a program for clients with no existing program

    Contact: Jeanne Chapdelaine or Karin Schuman