Prospective Payment Specialists is able to provide a thorough, compliant and accurate review of medical records for appropriate assignment of the diagnoses and procedure codes, for all types of patient encounters following submission of each claim.

OUR SPECIALIZED CONSULTANTS MAKE THE DIFFERENCE.

A unique aspect of our approach is that our consultants specialize exclusively in each service we provide. Those who perform the Coding Validation Review are all domestic HIM professionals (RHIA, RHIT or CCS) with a minimum of ten years of coding experience before joining PPS. In the niche created by the Prospective Payment System, it is imperative that each consultant knows compliance and financial ramifications from a technical, coding, and reimbursement standpoint.

FEEL CONFIDENT ABOUT OUR ACCURACY.

Our staff maintains a 98% accuracy level in the coding performed while adhering to high productivity levels. Please contact us to inquire about our productivity standards. All PPS staff members are peer reviewed regularly.

ENSURE COMPLIANCE.

A PPS Post Billing Coding Validation Audit can ensure billing compliance for your facility’s billing. When providing coding validation, we will review all codes that are assigned, not just those that would change the DRG.

CUSTOMIZE A POST-BILL AUDIT TO EXPLORE YOUR AREAS OF CONCERN.

Let PPS take care of your next coding audit, large or small, customized to your facility’s specifications. Coding Validation is a great way to ensure on-going 98% coding accuracy and compliance. We can provide a snapshot of how your coders and auditors are handling some of the most difficult or complex types of charts at your facility. These reviews are a perfect way to delve into the types of opportunities that may be available to your coding staff.

EDUCATION REINFORCES OUR FINDINGS.

A review of this sort can set the stage for education where our Consultants or our Physician Consultants will provide educational seminars or one-on-one sessions that will pinpoint the type of opportunities that exist for your coding staff and physicians. We can provide the guidance and education needed to ensure your required accuracy and production rates.

  • An on-going audit process to ensure compliant coding, documentation and billing
  • We can assist with selecting the sample to be reviewed
  • Can be conducted yearly, bi-annually, quarterly, or on an as-needed basis
  • Education sessions based upon audit results for improvement of coding and documentation
  • Education can be on-site, webinar or teleconference
  • Education as directed by facility management based on issues revealed by audit
  • Validation method reviews all codes assigned, not just those that would change the DRG
  • Project can be performed on or off-site
    Independent review by a third party
  • We have experience providing education to physicians and coding/billing staff
  • CEUs are provided with education