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Compliance and Coding

Billing and Compliance Services for Healthcare Providers, Medical Coding

Take all revenue opportunities, maximize reimbursement and comply with all billing requirements with coding, compliance services for hospitals, health systems and physician practices.

Optimize Revenue, Reduce Risk together with Medical Coding Services and Healthcare Regulatory Compliance Services

For hospitals, physician practices and other providers, two Issues matter when it occurs to billing for clinical services: Enlargement revenues and reducing regulatory risk. with a complex regulatory environment and persistent federal and state audit initiatives, medical coding operations and billing at hospitals and physician practices must comply with all useful healthcare laws and regulations.

Lost revenue from poor medical coding practices can negatively impact financial performance. With ICD-10 coding firmly in place, the industry is experiencing some negatively healthcare reimbursement trends: payer system inaccuracies, denials due to unspecified codes and other non-standard submissions, an increase in medical necessity denials, slower payments, and underpayments – all of which put healthcare organizations at risk.

The solution is a, hands-on medical coding, regulatory compliance program. The program includes both the review, monitor and tracking of each medical claim and the identification of disconnects that bring errors to the payers’ attention and/or identify where further education and assessments are needed to improve performance across the organization.

WRC Compliance Services and Medical Coding can assistance organization effectively manage denials, increase payment velocity and transition to value-based care, all with experienced coders who exceed industry standards of excellence.

Complete medical coding

Outsourcing to episodic project work, our coding services direction both sides of coding by identifying missed revenue opportunities as potential compliance risks due to inaccurate coding.

  1. Medical Coding Services for Any Care Setting, Any Duration: We can help Organization improve accuracy with ongoing, periodic or one-time coding assistance across all medical specialties, care settings or with hospital charge capture assessments.
  2. Clinical Documentation Assessments: WRC can conduct periodic audits of Organization internal operations by department and by provider to give a check on coding and documentation processes and performance.
  3. Physician and Staff Training and Education: provide on-site or virtual training to address coding and documentation processes deficiencies. Programs for improving the clinical documentation of the WRC, doctor training sessions and medical records services will help position employees for more effective documentation, receive reimbursement that Organization must pay for the services provided.
  4. ICD-10 Deep Domain Expertise: Our coders successfully managed the transition to the ICD-10 code sets for our customers and stay committed to monitoring ongoing code additions.

Services to ensure compliance with regulatory health requirements

WRC Medical Coding and Compliance Services have, in addition to coding management, an additional oversight function to organizations for providing information and guidance on adapted federal and state statutes, regulations, and other payer requirements. Many compliance services are available to healthcare organizations with their own medical billing coding teams.

  1. Evaluations of the health care compliance plan: for organizations with their own coding commands, we can evaluate your coding and compliance procedures using federal and state requirements as our guidelines. Evaluation will be integral, as you switch your team’s attention to the provision of value-based services.
  2. Developing and monitoring the compliance plan: We can help the team establish standards for coding and documenting best practices, as well as audit and confidential reporting processes, including guidelines for compliance, response and prevention.
  3. Specialized audit: we can view and evaluate the groups / persons responsible for monitoring, tracking and reporting, to identify gaps in code assignment and modifier, opportunities for improvement.
  4. Training services for service providers: WRC-provider services are designed to optimize interface and back-accounts. These services, which are offered on an annual and one-off basis as necessary, include:
    • A. Supplier Documentation Training
    • B. Annual updates / changes in the encoding of CPT and ICD-10
    • C. Determination of the national coverage and determination of the definition of local coverage for the adoption of CPT / ICD-10 coding
    • D. Updates of regulations affecting coding / documentation (eg, Quality Assurance Program, IDTF Policy Changes, Stark Law, etc.)

The power of WRC Coders

Correct coding of the organization’s services requires well-trained and experienced specialized medical coders and coding management. Currently, the WRC has more than 300 specialized certified coders, which annually receive more than 10,000 hours of training on compliance issues.

  1. Certification of special coding: for the solution of nuances of special encoding WRC with partners have developed certificates of special coding (SCC). After intensive training, coders must pass the SCC exam and accurately copy the selected diagrams with the correct CPT, modifier and ICD-10 codes for the graphs of objects and non-objects.
  2. Certified: All employees who issue encoding instructions inside or outside, including coding managers, supervisors and team leaders, are also certified at the national level as a Certified Professional CPC or CPC-Hospital (CPC-H) and work one on one with their encoding staff.

Mission

Our compliance efforts are aimed at creating a culture that helps prevent, identify and resolve behaviors that comply with federal and state legislation, as well as the requirements of federal, state and private health care payers, as well as the ethical and business policies of WRC.

  1. Quarterly quality checks: all production coders undergo a quarterly quality audit (QA) audit in their specific area. Approximately 50,000 items are revised as part of the quarterly QA coding process. The performance of coding is measured based on work quality and permissions. Work on improvement never stops.
  2. Annual external audit: to confirm that the supervision and direction of the WRC are objective and in accordance with industry standards, every year an external audit firm reviews a sample of claims that the WRC conducted.
  3. Confidential reporting: WRC maintains an anonymous compliance hotline through an external vendor so that employees report compliance issues confidentially and are not afraid of bad consequences. Questions reported on the hotline are carefully studied, and corrective actions are taken if necessary.