Medical Coding
Mosaic offers accurate, reliable and quality coding solutions to all clients. Whether an individual physician practice, small to large physician group or a specialty practice, we deliver guaranteed medical coding accuracy and demonstrable results.
Our medical coding services are delivered by experts with years of proven experience and who are well versed with current CMS guidelines and best practices.
We also train and develop our team members so that they are particularly proficient in use of varied EMR’s and other Healthcare Information systems including Allscirpts, Aprima, AthenaHealth, Care360, Cerner, Dr. Chrono, eClinicalWorks, Epic, Greenway, McKesson, NextGen, Practice Fusion and many others.
HCC Coding – Risk Adjustment Coding
RAFs (risk adjustment factors) are variables or conditions that make one patient more likely to need expensive or frequent medical care than the average patient. CMS allocates more resources proportionately to patients who have more severe conditions or carry a higher RAF score.
To that end, CMS uses the HCC (hierarchical condition category) method for determining risk scores for each patient. Diagnoses must be reported via ICD-10 CM coding, but not every single diagnosis actually risk adjusts.
CMS regularly revises these risk adjusting conditions, and their corresponding disease codes, based on what it considers as conditions or illnesses requiring more resources.
Our experienced coders carry out HCC coding reviews and identify the correct codes and any missed diagnoses. These recommendations are based strictly in compliance with CMS guidelines for diagnosing conditions and reporting through the correct ICD codes and code combinations.
Through accurate coding, you will receive an accurate risk adjustment factor (RAF) for all your patients which will ensure maximum reimbursements and optimized revenues for your practice.
HCC Coding – Data Validation – Documentation Review
Assigning the right Risk Adjusting code to a condition is only one factor in determining reimbursements. The other crucial factor is accurate and complete Documentation of all medical care rendered by a health care provider. Data records and evidence supporting all diagnoses are required for CMS to validate a given patient’s medical condition/s and consequently their Risk Score.
We also carry out Data Validation and Documentation Reviews to ensure that all diagnoses are reported in mandated format and claims are submitted correctly as per CMS guidelines. This reduces overall claim rejection instances which ensures timely and maximum reimbursements.
Reducing claim rejections also saves time and resources that go into re-submissions and corrections.
Claims Edit/Review
Rejected or Denied claims require immediate attention. We offer Claims Review services where we work on these claims to address and manage reasons for denial. We can review these in line with insurance company’s policies and procedures for accurate claims management. We manage these claims based on diagnosis and procedure codes assigned and resubmit after corrections are applied.
Provider Training
Informing our partner providers and sharing best practices from CMS and industry is an integral part of our service. This knowledge sharing ensures that any gains or improvements in processes or results are made a permanent part of the overall performance.Throughout our collaboration, we ensure that our partner providers are given timely and accurate feedback of services performed and results achieved. This timely and mutual feedback ensures that we continue to achieve better results together.
Click here to read about the significance of HCC, Risk -based coding.