Emergency Medicine presents a unique set of challenges for coding. This fast paced high-volume specialty encompasses elements of primary care E&M services up to trauma services. Surgical procedures are performed and diagnostic tests are ordered. Diagnostic coding is critical to present the medical necessity for each. Documentation must be precise because nothing can be assumed. Unfortunately the physicians’ notes are not always expansive as they need to be; discrepancies with the doctors’ notes, the nursing notes and the doctors’ orders are commonplace. Considering the number of patient visits, the ED coders must have an intimate understanding of what happens in the ED and they must be continuously inserviced and Q/A reviewed to avoid institutionalizing misunderstandings and thus making coding errors an “intergenerational” legacy.

Emergency Medicine Coding Needs:

Well trained emergency medicine coders for both professional and facility charges in the emergency department are hard to find, expensive to hire, difficult to keep, and their “care-and-feeding” is costly.

Few emergency medicine coders are certified, a symbol of career commitment and quality coding.

Coding guidelines for the facility and professional services are complex, change often and are different for the two segments.

Coder turnover and absences create cash flow peaks and valleys.

With so few coders specializing in this niche, it is difficult to find and hire experienced emergency medicine coders, even in large metropolitan areas. EDs in smaller communities and tight labor markets have trouble filling openings and often must offer pricy sign-on bonuses or other incentives that have the potential to create friction with the existing staff.

Facility coding guidelines have no national standard. Those guidelines created by individual hospitals often undervalue services.

• Ambulance
• Anesthesia
• Cardiology
• Cardiologist
• Credentialing
• Dermatology
• DME
• Family Practice
• Gastroenterology
• Radiology
• Rheumatology
• Skilled Nursing Facility
• General Surgery
• Healthcare
• Hospital
• Mental Health
• Neurology
• OB and GYN
• Oncology
• Optometry
• Orthopedic
• Otolaryngology
• Pain Management
• Sleep Disorder
• Sports Medicine
• Urgent Care
• Pathology
• Pediatric
• Physical Therapy
• Physician
• Plastic Surgery
• Podiatry
• Primary Care
• Psychiatric
• Pulmonology
• Radiation Oncology
• Urology
• Wound Care

Ambulatory Surgery Centers, known in the medical community as ASCs, are healthcare facilities that focus on outpatient (same day) surgical care. In 1970, the first ambulatory surgery center, coined Surgicenter, opened its door with five doctors performing surgery on opening day. Up until that time, all surgeries were performed in the hospital, which resulted in longer wait times for procedures, days spent in the hospital, and higher medical bills. The opening of the first ASC changed the way surgeries were performed and have since become a trend in the medical industry.

Today, with advancements in technology increasing the number of procedures that can be performed as outpatient, the demand for ASCs continue to rise. Surgeries such as a hip replacement, which used to require days of hospitalization, can now be performed as an outpatient procedure.

When it comes to medical billing and coding for ASCs, there is no room for error. With the centers already under financial pressure, delayed payments are not an option. That means that medical codes must be entered correctly and the billing staff must be top of the line in order to receive reimbursements for every rupee owed, and quickly.

Coding isn’t for the lighthearted or the inexperienced. The right coding has the power to reduce denials and exponentially increase successful claims. Accurate coding means accurate charges for every patient treatment, consultation, and medication. On the other hand, sluggish, inaccurate coding can back up revenue in a traffic jam of denials. You can prevent these costly mistakes by knowing all coding updates as well as the specific challenges faced in your practice or hospital. Having a complete radiology report can help ensure you and your team are using the right codes. Coding precision and accuracy results in maximum revenue for any healthcare organization.

Radiology is ground zero in the efforts to reduce health care usage. We can help you respond to this pressure, without reducing revenue. At Aver Healthcare, we turnaround most claims within 24 hours – with STAT claims approved within 20 minutes or less. And our insightful data analytics help radiology practices get even better. Our teams of certified coders know how to code, capture, and bill for every image, and have experience in radiology to lead the charge to win pre-authorization, coding, and billing battles for our clients.

Aver Healthcare provides medical coding audits for private/public sector and government agencies nationwide. Quality and compliance are of the utmost importance in medical coding and auditing for all patient settings. Our certified professionals and auditors can assist with general healthcare and medical coding audits as well as quality control procedures.

General Medical Coding Audits

General audits offer visibility into departmental operations and coding processes. Medical coding auditing is so valuable to accurate data collection, record keeping, and billing that providers are advised to conduct external audits at least once a year. External audits objectively analyze operations, and uncover deficiencies.

By following through in three key steps – preparing for the audit, managing the audit, and implementing the recommendations, HIM departments can make the most of external audits, and achieve a clear return on investment.

Internal Medical Coding Audits

First party audits (internal audits) declare organizational compliance with the ISO 9000 standard. This internal audit is a “self-declaration,” and external organizations perform audits to guarantee compliance, find deficiencies, and offer recommendations for improvement.