Administrative Service Organization Services

Coding Training and Compliance Review Services


Coding and documentation requirements, along with compliance regulations, change all too frequently. To keep our clients abreast of changes in coding, documentation, and compliance, PCG has developed a series of training and compliance tools that can be tailored to meet your needs.  Our team includes coders certified through nationally recognized organizations, such as the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).  Trainers are certified and/or approved through these same organizations. PCG’s Coding Training and Compliance Review Services can be provided onsite or via WebEx, or we will work with you to determine alternative delivery methods that fit your requirements.

PCG performs the following services:

Coding and Documentation Training:  Certified coder trainers create trainings that cover all facets of the coding and billing world. Examples of our comprehensive trainings include:

  • ICD-10-CM Coding and Documentation: Train providers, nurse care reviewers, or coding staff on the requirements of diagnostic code guidelines, selection, and the documentation that must be in the medical record to support the selections. Training can be comprehensive or focused on specialties.

 

  • ICD-10-PCS Coding: As with ICD-10-CM, the selection of services for the inpatient setting changed significantly with the adoption of ICD-10. PCG provides training to better understand root operations, new terminology, and how to use the tables to build the correct code that supports all performed services

 

  • Evaluation and Management (E&M) Training: Both experienced and new providers will benefit from updated and yearly training on how to document a problem visit note.  E&M is core to both inpatient professional services and outpatient clinics. Give your providers an edge in understanding how to level their services appropriately based on quality documentation.

 

  • Coding Certification: Does your facility or clinic have “coders” on staff that would benefit from being certified? PCG has a certified coder trainer that will provide training on all aspects of the exam requirements.  With PCG’s training, your coders will understand the requirements, the best use of tools, and how to apply coding knowledge to complete the exam with confidence.  Previous trainings have resulted in nearly 90% of class participants passing the exam on the first attempt.

 

Compliance Reviews:  PCG brings years of compliance knowledge for inpatient and outpatient facilities and services.  Compliance Reviews can include a full revenue cycle assessment to determine gaps in best practices.  A forms review will determine if forms and templates used to document rendered services are compliant based on documentation and coding guidelines, payer guidance, and the requirements of other certifying bodies that must be met by your team.

  • Full Compliance Review: A full revenue cycle review, including a forms and template review, will be performed to track and crosswalk all necessary compliance regulations.  From beginning to end, the revenue cycle will be cross-walked to internal forms with an Executive Summary providing guidance of what forms or templates are compliant, which ones need improvement or updates, and what is missing and needs to be created. 

 

  • Forms and Template Review: As noted in the Full Compliance Review, this review focuses only on the forms and templates used by your facility or clinic and their compliance. It will not include a gap analysis of your revenue cycle.

 

  • Training and Implementation: PCG can provide training on how to correctly use your forms, assist in creating the missing forms, and ensure proper implementation and completion of your new medical record forms.  Guarantee compliance from the start by providing support on the use of new forms. 

 

  • Policies and Procedures: New processes require instructions in addition to training. PCG will create a Policy and Procedure manual surrounding your forms, including examples of blank forms and forms that have been completed correctly.  A solid compliance plan starts with thorough instructions and a foundation in policies and procedures.

 

Interested in learning more about our Coding Training and Compliance Review Services? Contact us today. 


Administrative Services Organizations (ASO)


PCG has expertise in the creation, implementation, and management of Administrative Services Organizations (ASO).  This service provides the first line of defense between a provider and fiscal intermediaries to ensure that submitted claims meet federal, state, and local Medicaid claiming policies. We partner with state Medicaid programs to provide oversight and management of specific healthcare services and/or beneficiaries, such as school-based healthcare.

Due to the need to be fiscally responsible and to ensure compliance that can withstand external CMS audits, program oversight is imperative. Program oversight provides a level of comfort for both the agency and the healthcare finance department that claims are clean and disallowances are reduced.  PCG’s Revenue Cycle team is experienced in all phases of ASO functions, from documenting regulatory requirements, to providing and implementing automated systems to process and evaluate claims, to providing independent oversight of operational claiming processes.

PCG performs the following services:

  • Creating and supporting a clearing house claiming database for each program or service
  • Importing patient eligibility, provider data, and other regulatory required data to meet claim validation needs
  • Performing front-end validation of claims data prior to claim generation
  • Generating and submitting claims
    • Research denials prior to claim submission to the fiscal intermediary to determine corrections, thus reducing denials
  • Claim Management
    • Posting and reconciling payments
  • Working with providers to resolve workable denials and rejections
  • Training providers on industry best practices and payer rules
  • Creating standardized and ad-hoc reports
  • Creating program-specific audit processes based on regulatory requirements
    • PCG has a web-based application that can be customized to produce agency-specific medical record documentation requirements to review medical records for compliance
    • Our application produces a pass, fail, deficient results spreadsheet, allowing Healthcare Finance and agency stakeholders the data needed to improve documentation best practices
    • Audits can be used to support internal compliance plans and to support auditing and monitoring practices
    • Audits are performed by Certified Coders/Auditors and support the need for third-party disinterested medical record assessments
  • Revenue Cycle and Regulatory Consulting

Areas supported by PCG include:

  • Support with external audit requirements, results, and rebuttals
  • Annual review of service codes (CPT) and diagnostic codes
  • Assistance with and training on documentation requirements for new codes
  • Support with medical record forms review to ensure compliance based on federal, state, and local requirements