Billing and Coding Compliance

As a result of the constant regulatory changes pertaining to compliant billing and coding, healthcare practitioners and facilities alike are faced with decreasing profits and escalating costs. Institutions are constantly seeking ways to optimize reimbursement and are likely to find it a challenging task.

Billing and Coding Compliance

  • Seasoned professionals able to interpret various principles, processes and obstacles that govern compliant billing and coding
  • Minimize compliance risk by assessing organizational threats and opportunities, revising policies and procedures, providing appropriate solutions for responsive action, and managing the impact that industry changes may have on an institution

Further complicating matters, managed care and regulated health insurance companies are becoming increasingly savvy with cutting costs and refusing payment for services. Governmental payors have put reimbursement recovery measures into place with the Recovery Audit Contractor (RAC) Audits which are causing a significant work effort to manage the audit process. Medicare Severity-Diagnosis Related Groups (MS-DRGs) has posed another obstacle for providers, many of whom are facing the possibility of declining Medicare reimbursement. Access to appropriate resources and technical expertise as well as the efficient management of organizational risks are essential in generating the increased revenue necessary for a healthcare institution’s survival.


Provident Management Consulting’s billing and coding professionals have developed tools and techniques designed to identify cost containment and reimbursement opportunities. Our customized processes allow us to effectively identify problem areas and provide our clients with workable solutions. Areas in which our certified coding professionals offer assistance include:

  • MS-DRG Reviews
  • RAC Audit Reviews
  • Ambulatory Payment Classification (APC) Reimbursement Recovery Reviews
  • Concurrent/Retrospective Evaluation and Management Documentation Reviews
  • Multi-specialty Billing and Coding Assessments and Reviews (e.g., Radiation Oncology, Interventional Radiology, Cardiology)
  • Charge Description Master (CDM) Reviews
  • Office of the Inspector General (OIG) Work Plan Initiative Reviews
  • Reviews of Carrier/Fiscal Intermediary Specific Issues [i.e., Local Coverage Determinations (LCDs)]
  • Compliance Program Risk Assessments
  • Function as your Independent Review Organization
  • Billing and Coding Education/Training for physicians, nurse practitioners, physician assistants, coding/billing staff, etc.
  • Interim Staffing Initiatives


As a provider of in-depth billing and coding compliance guidance to academic medical centers, community hospitals, and private practice groups, Provident has developed a systematic means of analyzing client needs in the billing and coding service area and assisting our clients to negotiate the demands of compliance risk management. Our billing and coding service professionals work with an institution’s senior leadership, compliance, health information management staff, and others to develop a customized plan to minimize regulatory risks and implement best practices to service the needs of the institution’s overall billing, coding, and compliance initiatives. We understand the complexities of regulatory requirements and the demands of profitability and aim to ensure our clients’ organizations not only survive but succeed.

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