Medical Coding & Documentation GapAssessment with Targeted Education

SCALE Case Study:

Client Profile

Services Deployed

Medical Coding & Documentation Performance Assessment

Medical Coding Program Assessment

Focused Education

Situation

SCALE’s Client, who provides emergency medical and specialty hospital services with facilities in thirteen states., desired a thorough understanding of its current medical coding & documentation practices and how they compared to best practices and OIG requirements. The Client, who also oversees independent physician associations (IPAs) and managed service organizations (MSOs) that staff these facilities, wanted to provide education & training to coding staff to mitigate financial and compliance risks associated with recent findings. SCALE was engaged to perform a baseline gap assessment of current documentation and medical coding practices for facility and professional
services claims.

Execution Approach

SCALE’s Medical Coding Audit & Documentation Assessment evaluated two distinct methods of assigning Evaluation & Management (E/M) CPTs: Professional (Physician) Fees and Facility Fees. The professional fee E/M claims assessment aimed to determine coding accuracy based upon analysis of medical documentation supporting providers’ cognitive work.
SCALE developed an Executive Report Card, which identified the level of risk each finding represented, providing actionable results which were used to ensure the Client’s compliance with documentation and coding best practices.
SCALE’s Coding & Documentation Assessment identified staff coding patterns commonly associated with potential revenue loss and provided recommendations and strategies to limit revenue loss due to medical coding errors.
SCALE’s Coding & Documentation Assessment identified staff coding patterns commonly associated with potential revenue loss and provided recommendations and strategies to limit revenue loss due to medical coding errors.
SCALE’s Coding Program Assessment confirmed that the Client’s coding practices align with payer and OIG standards and current best practices, providing reassurance to the Client.

Key Results

Medical Coding & Documentation Assessment

SCALE was able to provide the Client with a holistic picture of its current medical coding & documentation practices by including both professional service claims and facility services claims which are coded using different methodologies.
Identified a gap / opportunity in Client’s Facility E/M Guidelines not being consistently applied
Executive Report Card developed to help break down the Client’s risk-levels in order to give them better insight into their coding performance

Focused Medical Coding Education