Expert coding ensures compliance with both the Centers for Medicare and Medicaid Services (CMS) regulations and commercial insurance regulations regarding quality and reimbursement. Fotheringill & Wade, LLC’s coding team takes a unique perspective to coding denials. We believe that each record stands alone and a thorough review of the medical record will determine the correct coding for each claim. Rather than simply rebilling the claim, our clinical coders conduct a thorough analysis of the medical record and write a detailed appeal to defend the codes and support the DRG billed.
Inpatient Coding Denials
Because F&W’s coders review the majority of coding denials from a clinical standpoint, our coders are able to defend coding denials in all aspects of the inpatient setting. Our certified coders are also clinicians with extensive acute care experience in all areas of the inpatient setting, including critical care, medical and surgical. Our clinician coders are experts in coding difficult and complex diagnosis codes, sequencing and exclusion code denials. We identify patterns and trends from all categories in order to defend the hospital coding and provide specific feedback for documentation improvement.
Outpatient Coding Denials
Our certified coders are experts in coding evaluation and management services, emergency room, operative and procedure notes, therapies, bundling and appropriate modifiers. We have successfully defended unlisted procedure codes through a detailed analysis of the patient’s medical record and in depth explanation of the necessity of the procedure.
A hospital’s chargemaster should accurately reflect every procedure, service and supply in the facility. F&W’s coding team evaluates the effectiveness of your chargemaster and reviews for accuracy of HCPCS/CPT and revenue codes. We identify errors and work with management for more accurate coding, charging and billing for each department or practice. We perform monthly reviews and provide specific, brief educational sessions centered on the previous month’s findings.