Welter Healthcare Partners stays informed of changing coding standards helping you to maximize reimbursement and mitigate risk
Welter Healthcare Partners stays informed of changing coding standards so you don’t have to.
Coding Compliance and Audits
Regular coding audits can reveal a multitude of issues such as:
- Outdated or invalid codes that can result in claims denials.
- Over-coding that can result in payer audits, fines and repayment of funds.
- Under-coding that can result in a loss of appropriate practice revenue.
- Inappropriate coding practices such as unbundling, inappropriate modifiers, inappropriate use of incident-to, inappropriate use of locum tenens. These are just some errors that can result in fraudulent billing practices, payer audits, loss in revenue and possible regulatory intervention.
- Insufficient documentation to support the codes billed.
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- Providers are not typically trained on proper coding and documentation as part of their formal education
- Whether you are leaving money on the table or putting your organization at risk for a payer audit, the financial impact of missing documentation can be substantial to your organization
- CMS (Centers for Medicare and Medicaid Services) requires annual provider audits and education by an external third party
- Coding rules and guidelines constantly change, not staying up to date will affect your reimbursement
- Stay up to date with the OIG (Office of Inspector General) annual work plan & enforcement activities to combat fraud
- Track your organization’s and provider’s accuracy and coding success through specialized reporting
- CMS (Centers for Medicare and Medicaid Services) requires organizations to have a written coding compliance plan
- Our 30 years of experience with coding compliance will give your organization the ongoing support it needs
- Our team will support your organization in the event of a payer audit and take-back request or other regulatory intervention
- CMS (Centers for Medicare and Medicaid Services) requires annual audits and education by an external third party
Outsourced Coding Reviews
Risk Adjustment Factor (RAF)
With expertise in Risk Adjustment Factor (RAF) coding, Welter offers services such as RAF program implementation, RADV (Risk Adjustment Data Validation) audits, physician and coder education/support, and clinical documentation improvement. Our approach includes ongoing training, monitoring, and performance improvement measures to ensure compliance with risk adjustment factor scoring.
Welter aims to help providers document accurately, ensuring the highest level of specificity in diagnosis coding and communication of risk.
Are you unsure about how to code and bill for a service? Our expert team can assist your practice in finding answers to your most challenging coding issues and questions. Our team is committed to going above and beyond to solve even the toughest coding conundrums. Practice coding and billing specialists face challenges in keeping practices financially viable. We provide expert mentoring to your staff, including provider communication techniques, new coder development, process improvement strategies, escalation of compliance issues, and team building. Our mentoring helps your team acquire the necessary skills and knowledge to overcome these challenges and ensure your practice’s financial success.
We partner with our clients to design roadmaps and workflows that ensure success in the areas of coding and compliance, enabling your practice to maximize revenue while maintaining regulatory compliance.
Independent Review Organization (IRO)
Corporate Integrity Agreement (CIA) reviews as an independent review organization. In response to escalating allegations of fraud and abuse associated with unlawful billing and coding practices, certain physicians and practices are mandated to enter into Corporate Integrity Agreements, which necessitate engaging an Independent Review Organization (IRO) to assess their billing practices. Serving as an IRO, we conduct thorough and impartial reviews tailored to the requirements of the CIA. Our evaluations focus on CIA compliance, executing necessary review procedures, and delivering training to prevent future deficiencies.
As one of the only CIA review organizations, we can help to protect your practice and revenue.
“For strong coding and billing compliance program… Welter has been a great collaborator”
In an environment of increasing scrutiny and regulation it has never been more important to have a strong coding and billing compliance program in place to demonstrate the commitment of the organization to ongoing review and improvement. While it is important to do this on a continual basis internally, it is extremely helpful to have an independent review and independent reinforcement of the coding and documentation principles for the providers as well. Over the last 15+ years, Welter Healthcare Partners has been a great collaborator, helping us to develop a strong review and feedback program that works for our organization. Welter Healthcare Partners staff is consistent and reliable and they allow for participation of the internal coding and billing staff in the educational meetings. I think that is the part I appreciate the most – the collaboration and the support. They reinforce what we are already telling our providers about the importance of accurate and compliant coding and billing.
Maggie Amero, CPC
Director of Physician Revenue Cycle
Boulder Community Hospital Physician