Clinical Compliance & Reimbursement

Strict enforcement of coding and documentation requirements has forced many healthcare providers to evaluate their current practice patterns to ensure regulatory compliance. PYA Assessment Services staff provides clients the information they need to determine overall risk of compliance exposure. Our comprehensive assessment services incorporate a comparison of initial encounter data, medical record(s) documentation, and claims data that includes the original claim form and Explanation of Benefits (EOB)/Remittance Advice (RA). We provide these services to a wide range of healthcare providers that include hospitals, physicians, physician extenders, teaching physicians and residents, and home health agencies.

PYA recently assisted a large regional health system assess its quality of coding across patient types and analyze DRG trends compared to national benchmarks. Our work for the system mitigated the risk of inappropriate coding/billing and identified areas for internal monitoring according to state and national focus.

In addition to assessment services, PYA provides extensive education and training on coding, documentation and billing topics. These sessions may be conducted in several formats, ranging from large group presentations to one-on-one customized training that is based on the provider’s actual documentation. Our customized education sessions are effective in preparing providers and coding/billing staff on compliance related issues. In addition, we have developed training tools that may be utilized during each session.

At the completion of each session, the provider receives a set of training tools for future reference. PYA’s billing compliance assistance and guidance is applicable to all healthcare providers, including hospitals, physicians, and third-party billing companies. Our billing compliance assessments help ensures efficient and effective processes that comply with regulatory and private payer requirements. Our billing compliance assessments also can include an assessment and review of the billing process from an operational and technical standpoint, and we can assist in ongoing billing coverage related research and support.

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