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Medical Coding Process

Medical coding plays the key function in the reimbursement of the healthcare providers and/or practices. ClaimsXperts medical coding team functions with you, the Business Partner, in mind to assure you peace of mind by our HIPPA compliant practices and by assigning the most accurate ICD-9, CPT & HCPCS codes.

We have a team of CPC credentialed coders who are domain experts with hands-on experience in respective specialties;  every individual coder has strong knowledge of compliance and reimbursement procedures. In turn this equips us to handle the medical necessity, bundling issues etc. with utmost proficiency.

Our coding team works in tandem with the denials processing and the data entry teams, to capture the latest payment patterns and the insurance updates; the coding team documents these instructions and is regularly trained with the refresher programs.

The key aspects of medical coding are
  • To understand the services provided,
  • To be able to identify the billable components of these services,
  • And to translate them into a compliant set of codes,
  • In the light of the carrier rules and specifications,
  • To facilitate the maximum reimbursement in the shortest possible time.

ClaimsXperts’s Coding team is lead by team of professional leaders who posses over 40 + man years of experience in US healthcare which is spread across revenue cycle, coding and billing  functions and  has a highly committed team which focuses on the sustained revenue gain and success of our business partners.

The ClaimsXperts healthcare medical coding team primarily deals with the following functions for its physician billing company and hospital clients:

Coding: Assigning the codes using the ICD-9-CM, CPT & HCPCS in accordance with the latest guidelines.

Compliance: Knowledge of the application of Correct Coding Initiative, Local Coverage Determinations and National Coverage Determinations.

Coding Denial Management: The coding denials are being analyzed in depth and appropriate actions are taken, with the review of the medical reports. We build a knowledge repository of all these denial case scenarios, which forms an important part of the coding refresher training curriculum.

Continuous Learning/Training: Internal need-based refresher coding trainings are built-in along with the domain/specialization trainings which are regularly scheduled; the coders' knowledge base is methodically evaluated on a continual basis.

Unique selling point or Key differentiator

Education of the Providers:

ClaimsXperts coding team is adept in reviewing the providers’ medical records and helping the healthcare provider with the inputs to improve the documentation, in all possible ways to maximize the billing for the services rendered. We are meticulous in bringing to the attention of our business partners, the services that were downcoded due to lack of documentation for the visits/services that are being coded by us; we are offering this as a value add for our clients.