Codebusters provides physicians in both small and large groups, IPAs, and multi-specialty organizations with coding and auditing services.  We work closely with you to understand your unique relationship to payers and affiliates to identify potential compliance risks.  Our professionals have experience across the professional services coding and billing spectrum.  Coding and auditing can be performed onsite or remotely.  We can provide training to your staff both onsite and via video chat.

Codebusters professional services coders have expertise across a broad range of specialties.  We work closely with our clients to ensure that they understand the documentation requirements for billing their specific practices, and capture all appropriate charges. 

 Practitioner Reimbursement Challenges 

The compliance issues surrounding billing within different sites of service and physician arrangements can be quite complex.  Additionally, E/M coding requirements vary within medical specialties, especially as it relates to medical decision making, creating the need for coders with direct experience in a given practice specialty.  Coders must possess strong knowledge of surgical and E/M CPT coding, modifier usage, and ICD-9 coding as it relates to medical necessity rules.  Coding staff should also be well versed with physician payment systems, such as RBRVS and the included Medicare global surgery package (GSP).

Physicians working out of clinics often maintain multiple relationships, i.e., being based out of a clinic, but working at a number of hospitals or specialty clinics. Establishing strong information flow mechanisms between the site of service and the medical clinic are crucial to appropriate access to documentation for coding and billing.

Codebusters approaches each professional services audit with the customer’s needs at the forefront.  Auditors can perform the audits and training feedback on-site or remotely.  We help physicians and NPPs, whether independent or part of a larger group, IPA, or hospital chain, abide by complex coding and billing guidelines so that they receive full compensation.  Each audit is designed around clearly defined parameters and existing compliance efforts.  As part of the planning stage we consider current and past compliance initiatives, the highest areas of risk, and budgetary restrictions.  Understanding the complex nature of physician relationships and contractual agreements is critical to apply the appropriate coding and billing systems.  The audit teams help practitioners alleviate the uncertainty with regard to proper Medicare and other payer billing through stopping patterns of errors, documentation training, work flow analysis, and proactive auditing.

The compliance concerns for physician coding and billing depend largely on the site of service and the practice specialty.  Primary areas of focus are proper diagnosis coding establishing the medical necessity of procedures performed and the evaluation and management (E/M) level, along with the appropriate qualifying modifiers.  E/M codes should be validated against the documentation to support the level of service provided by the physician or non-physician practitioner.  The application of 1995 or 1997 E/M Documentation Guidelines must also be reviewed for consistency and financial effectiveness.  Special focus should be spent on E/M codes for day-of-discharge management services, consultations, critical care services, psychotherapy, and individual psychiatric testing for inpatients.  The OIG has long investigated the use of E/M codes by physicians, typically looking for aberrant patterns skewed toward high volumes of high service levels.  Consultation coding is also a major area of focus by the OIG.  For physicians at teaching hospitals, documentation should be evaluated to verify that it supports the supervision of residents.