Medical Coding: Health Information Management
Professional (Physician) Coding
Physician practices often rely on uncertified coding personnel to complete their coding duties with the intention of keeping costs down. This can be problematic because of the complexities related to medical coding. Often times, this hurts practices in the long-run through high denials rates and decreased reimbursements.
Sutherland has helped a wide variety of specialty providers (including but not limited to orthopedics, vascular, neurology, gynecology obstetrics, emergency room radiology, cardiology, and more) with their coding needs. Our certified coders ensure claims are quickly approved and correctly paid in full the first time, helping physician practices to both improve reimbursements and reduce costs.
Facility medical coding is becoming increasingly tough. On top of that, to find well-trained hospital facility coders is a tedious and demanding process. It’s no wonder the industry is plagued with rapidly increasing costs.
Sutherland helps facilities handle their coding needs by leveraging first-class, certified coding talent from across the globe. Our services help facilities improve turnaround time, increase quality scores, and grow their bottom-line.
Accurate and efficient charge capturing is a crucial part of the revenue cycle process. Without a reliable charge capture process, healthcare providers often capture incorrect documented information, poorly-coded claims, and cost themselves immense amounts of money with decreased reimbursements.
Sutherland will digitize and improve the charge capture process for healthcare providers. Our robust and accurate processes help healthcare providers save time and resources. The end result is improved collections, decreased operational costs, and a reduced chance of being audited.
Medical Necessity Checks
Medical necessity denials are some of the most common but complex reasons for claims denials. Especially if improper front-end processes were performed, the resources necessary to investigate and correct a medical necessity denial can be costly for even the largest of healthcare providers.
Sutherland partners with healthcare providers to document medical necessity for treating a patient’s medical condition. We perform medical necessity checks and then take a holistic look at our clients’ end-to-end processes to create automated processes that accurately document and handle the medical necessity documentation.
Pre-bill edits can help healthcare providers proactively prevent coding denials. It sounds great in theory, however, many providers struggle with implementing this mid-cycle process. This leads to increased costs, increased claims denials, and decreased reimbursements.
Sutherland’s pre-bill editing services help healthcare providers proactively fix potential claim edit issues. Our team of certified coding specialists look at the entire medical coding process to improve pre-bill services. The end result is increased claims quality scores, improved turnaround times, and, most importantly, a higher collections rate.
Clinical Documentation Improvement (CDI)
Complete and accurate medical record documentation is crucial to the overall success of all hospitals and physician practices. High-performing healthcare facilities and providers make it a priority to implement effective CDI programs to increase their medical records reliability, minimize incomplete documentation, and enhance overall patient care and experience.
Sutherland’s in-depth CDI services help healthcare providers enhance their documentation and mitigate risks. No two hospitals or physician practices are the same, which is why Sutherland customizes each CDI implementation around our client’s specific needs to create the best CDI solution possible.
To become a quality-driven, value-based healthcare organization, healthcare providers need accurate and complete clinical documentation within their medical records. The best way to know and improve the quality of clinical documentation is through coding audits. Coding audits specifically target and review diagnosis and procedural code selection, as well as abstracting as determined by the physician documentation within each medical record.
Sutherland provides comprehensive coding audits. Our certified auditors investigate areas of weakness and then work with our clients to identify opportunities for training, education, technology improvements, and process transformation that improves overall coding audits.
Medical coding is incredibly complex and keeping staff updated on all its nuances is both timely and costly. Healthcare providers need to implement or improve their provider education programs so they can improve documentation habits for accurate, compliant coding and improved reimbursements.
Sutherland is a trusted source for provider education programs. We bring in our certified coding experts to provide the most up-to-date curriculum and ensure our clients’ educational objectives are soundly met. These services keep healthcare providers educated and help ensure maximized reimbursement throughout their coding operations.
Denials are a major part of the healthcare provider’s world. Even the very best coding teams will eventually face the issue of handling coding denials. The concern is when coding denials rates happen with a higher frequency over time or within certain circumstances.
Sutherland provides coding denial services to help healthcare providers handle their denials backlogs and proactively prevent future denials. Our certified coding experts help to fix small but important issues, resulting in improved claims quality and increased reimbursements.