Audit & Compliance

Oxford HIM matches experienced coding professionals with excellent job opportunities in inpatient and outpatient coding compliance, ICD-10-CM, CPT, and HCPCS for a variety of healthcare facilities.

Our Staffing Consultants work with clients to understand the nature of each position, the required skill set, and the overall vision of their organization, and then together create the best staffing solution. To meet the unique needs of both clients and candidates, we offer short- and long-term contract, contract-to-hire, and direct hire assignments.

Inpatient and Outpatient Coding Compliance: ICD-10-CM, CPT, HCPCS

  • Validation of MS DRG or APC reimbursement systems and ICD-10-CM, CPT 4, HCPCS selection/assignment
  • Validation of principal diagnosis, first listed, and/or principal procedure selection/assignment
  • Validation of all secondary MCC, CC, and other reportable diagnosis and/or principal procedure selection/assignment, in addition to sequencing logic regardless of impact to MS DRG or APC calculation to ensure overall coding quality (full code review)
  • Validation of present on admission indicator issues
  • Validation of clinical/physician documentation improvement issues
  • Validation of query issues
  • Validation of date of service discrepancy issues
  • Validation of admission order, medical necessity, and patient-type issues
  • Validation of discharge disposition and transfer MS-DRG discrepancy issues
  • Validation of operational assessment related to coding – incomplete source documentation (medical record) for accurate coding and workflow issue
  • Validation of all above elements that directly or potentially impact undercoded and overcoded issues in addition to level(s) of severity

Also, where noted and/or requested will document discrepancies with the following:

  • Compliance with potential fraud and abuse issues
  • Compliance with federal/state and/or other regulatory entities
  • Compliance with research and defense of coding rationale when warranted in the execution of an appeals process (e.g., Corporate Audits, RAC Audits, MIC Audits, etc.)

Deliverables: Root Cause and Trends

  • Final Report with findings by coder and overall facility performance for MS DRG/APC and overall coding accuracy; where requested: discharge disposition, patient type, POA assignment accuracy rates via Excel and Word
  • Financial impact analysis based on findings
  • Education session for coding staff based on opportunities identified, and where requested and schedules permit, training on specific coding/abstracting/query logic (case by case option/assessment)
  • Exit interview and summary with hospital leadership administrative staff: CEO, CFO, Controller, Health Information Management Director, Coding Manager, etc.