HIApro – Professional Fee Consulting Service
Review Services
HIApro assists health systems and their employed providers by performing coding, billing, documentation compliance reviews and education. Our comprehensive service will discover trends that may adversely affect quality scores, identify high risk areas prone to payor audits, help reduce claims denials and ensure appropriate reimbursement.
Fulfill compliance plan requirements
Coverage for internal auditor vacancies
Onboarding newly employed providers
Special projects and investigatory reviews
Due diligence reviews for acquisitions
Coding Services
The number of physicians employed by health systems continues to rise. This growth will bring increased financial and compliance related risks. As the industry moves towards a value-based payment model, quality metrics and costs will dictate reimbursement. Additionally, government and commercial payors are poised to scrutinize claims more aggressively. The need for qualified professional coders has never been greater.
Internal coding staff vacancies
System upgrades/conversions
Backlogs, timely filing
Overflow needs
Month-end/Year-end support
Special projects
HIApro Offerings
Why HIA’s profee service is different
Our main objective is to help physician practices survive in an environment of increased payor scrutiny and declining revenues.
- Annual Client Satisfaction 98%
- Average Client Relationships Over 5 Years 95%
- Average Client Relationships Over 10 Years 85%
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Popular Posts
IPPS Proposed Rule: CC/MCC Designation Changes
Changes to CC/MCC designations included in the proposal could have a potentially dramatic effect on casemix. The presence of a major complication or comorbidity (MCC) or complication or comorbidity (CC) generally is representative of a patient that requires more resources.
It Only Takes One Code
How many times have you heard “it only takes one code to get the claim paid”? With the emphasis on the severity of illness and the move toward value-based reimbursement in today’s healthcare climate, it is more important than ever for coders to report all applicable diagnoses. There are three important pieces: what the provider documents, how to the coder interprets that documentation and codes it, and then how it is extrapolated.
How to Reduce Claims Denials
The reimbursement landscape is already a complicated one – and the highly-complex claims denials process only adds fuel to the fire. A denied claim is one that has been determined by a payor to be in appropriate. Once a coding specialist amends the errors on a rejected claim, they can resubmit it for consideration. The time-intensive process has a significant impact on the cash flow for any setting in the healthcare environment. They are also very costly to appeal.
Query Tip: Query for Clinical Validation
When a practitioner documents a diagnosis that does not appear to be supported by the clinical indicators in the health record, a coder has four choices: (1) Code the diagnosis; (2) Ignore the diagnosis; (3) Generate a query to confirm clinical validation of a diagnosis; (4) Follow the facility’s escalation policy for clinical validation.
$30M Settlement for Medicare Advantage Upcoding
A California-based healthcare services provider and several of its affiliates have agreed to pay $30 million to resolve allegations they submitted inaccurate information about the health status of beneficiaries enrolled in Medicare Advantage Plans, according to the Department of Justice.
HIApro Reports
HIA delivers comprehensive electronic daily and month-end reporting to its clients. The content and format of these reports promote transparency and allow for easy invoice reconciliation.
HIApro Reports
HIA delivers comprehensive electronic daily and month-end reporting to its clients. The content and format of these reports promote transparency and allow for easy invoice reconciliation.
