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AUDITING & COMPLIANCE ASSESSMENTS

iCodeHCS’ Compliance Plan

iCodeHCS has and will continue to be committed to the highest standards of integrity and accountability. iCodeHCS Compliance Plan has the following objectives:

  1. This coupled with the Code of Business Conduct, establishes a tone for conducting business ethically as well as reinforces iCodeHCS commitment to integrity.
  1. The Compliance Plan provides a basis for iCodeHCS to implement the organization’s Code of Business Conduct.
  1. Identifies how iCodeHCS sets expectations for compliance with existing laws and policies and subscribes to the accepted standards of business organization.
  1. The Compliance Plan complies with the federal law, which have been established regarding corporate compliance programs as well as with the Office of Inspector General’s (OIG’s) Compliance Program Guidance for physicians in small groups or private organization.
iCodeHealthCareSystem_iCodeHCS.com_Compliance
iCodeHealthCareSystem_iCodeHCS.com_Compliance-Auditing

We offer a variety of Auditing and Compliance Assessment services which include:

  • Inpatient/Outpatient Coding Assessments
  • Chart to Bill Audits
  • Evaluation and Management Audits
  • Revenue Integrity Evaluation
  • Charge Description Master Reviews
  • Medical Necessity Solution

Inpatient/Outpatient Coding Assessments

Service is our specialty, that why we provide a thorough review of medical records and compare existing documentation to services billed — ensuring accuracy and compliance with payer coding guideline and overall billing. Additionally we make assessments to see if there are additional services documented that should be billed beyond the primary.

 

Chart to Bill Audits

We work through Chart to Bill Audits by reviewing outpatient claims from different medical departments to determine if the services billed are properly documented in the medical record. These audits are completed through our use of the coding, billing, and documentation guidelines established by the Centers for Medicare and Medicaid Services (CMS).

 

Evaluation and Management Audits

In order to conduct this audit, we conduct in-depth review of medical records to compare existing documentation services billed for accuracy and compliance with Medicare coding guidelines. We support the development of Evaluation Management criteria for multiple outpatient departments like Emergency and Pain Management Service.

 

Revenue Integrity Evaluation

iCode can assist your company by conducting Evaluation and Management audits for multiple physician practices within your health care system. We understand the importance of ensuring existing practices are compliant in their billing and revenue cycle operations. Our core team of experienced coders can effectively provide coding, documentation, and billing compliance audits for physician practices and medical professionals.

 

Charge Description Master Reviews

Periodic on-site CDM reviews performed by a third party are essential to maintaining and accurate and up-to-date CDM. Our expert coders and coding professional specialize in assisting your facility in achieving CDM compliance, thus helping you to achieve long term goals with an effective Revenue Cycle and the submission of clean claims.

 

Medical Necessity Solution

We work as a third party to help review cases as a result of false claims during inpatient documentation practices. Incorrect diagnosis and procedure coding leads to overpayments and the false claims, mentioned above — for this we perform a case management operational assessment. We work with hospital case managers to resolve issues and create effective plans around medical record reviews that affect the accuracy of the level of care determinations and medical necessity.

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