Coding errors for mid-sized physician group reached <1%

The Client:

Mid-sized physician group based in the US

The Challenges:

• High coding denials
• Degrading coding quality
• Significant problems with coding
• High compliance audit risk

Plutus Health Plan:

Plutus Health’s certified coding experts implemented their plan by first identifying the coding issues along with the root causes.

Issues Detected

• Centralized coding team with no formal audits to check compliance risk, accuracy, documentation requirements, and provider education
• Lack of knowledge in coding updates, potential revenue loss, compliance risk, and cashflow issues due to denials

After detecting the problems, we worked extensively to create a personalized action plan to provide an end-to-end coding solution to the client.

Our certified coders helped the client to fill coding gaps and improve accuracy.

Plutus Health Solutions

• Plutus Health’s certified coders (AAPC and AHIMA) helped the client increase RVU (Related Value Units) and HCC: RAF Score using payer-specific coding nuances.
• Plutus Health supported the client on payer pre-payment audits.
• Our specialist helped the client with compliance issues visibility and improved compliance standards by deploying a full-proof coding compliance plan and conducting timely compliance audits.
• We helped the client deal with staff shortages and provided quick, efficient, scalable solutions.
• Our experts offered coding/CDI programs specific to coding specialty and payer guidelines.
• We performed daily/weekly feedback on coding and documentation improvement opportunities.
• We provided a weekly performance dashboard to report accuracy, RVU, and error trends.
• Plutus Health provided physicians coder feedback, education-based error trends, and coding updates.

Results

• Coding quality for the client improved.
• Increased coding accuracy for the client.
• Improved clinical documentation.
• Eradicated compliance risk.

Achievements

• The average coding accuracy for the client constantly improved >95%.
• Coding denials <1%
• The coding quality of the client reached >98%