Validation and the coding for DRGs, and Outpatient cases have been primary services for PPS for more than 25 years.

Prospective Payment Specialists is able to provide our clients with a thorough, compliant and accurate review of Inpatient, Outpatient, ER, Physician Practice, Same Day Surgery or other medical records for appropriate assignment of the diagnoses and procedure codes.

PPS provides recommended changes in the assigned coding within an average of eight hours of receipt of the cases. Plus, PPS has the flexibility to modify these services based upon your direction and needs.

  • Examination of DRG, APC, Outpatient Surgery, Wound Care and other cases and corresponding bills for safe and accurate coding, documentation and billing, after coding, but prior to billing
  • Personnel are all HIM professionals: RHIAs, RHITs and CCS with a minimum of 10 years coding experience prior to joining the PPS team
  • Physician education, as requested, by our staff of physicians to alleviate subjective or ambiguous documentation
  • Service can be on-site or off-site
  • We have extensive experience with most EMR systems
  • Validation approach reviews all codes assigned, not just those that would change the DRG Reporting by case and provide statistical analysis
  • Diabetes mellitus and inpatient coding with MS-DRGs
  • ICD-10 coding for heart murmurs
  • Coding guidelines for pathology reports
  • ICD-10 coding for operative reports
  • Coding for observation services
  • Information on medical coding auditing tools
  • Medical coding audit worksheets
  • Anesthesia coding and billing audit
  • Residents and observation coding
  • Coding for teaching physicians
  • Cardiac catheterization coding or auditing for compliance
  • Accurate billing and documentation for APC assignment
  • Correct modifier usage and education
  • Correct E/D billing
  • Specialized expertise in wound care coding
  • Correct Observation billing
  • Years of E&M coding experience
  • Full range of education with experience with Doctors, Coders and billing staff
  • Validation of Medical Necessity coding and documentation
  • Pass-through rebilling