Coding Support and Management

QualCode works closely with healthcare providers to make sure they get paid for each claim. All services are available on a remote, on-site, per diem, and interim basis, including:

Inpatient and Outpatient Coding Support

Don’t let staffing shortages, seasonal fluctuations, or coding reimbursement updates affect your bottom line. QualCode’s expert coders have experience in a wide range of healthcare environments and are available on a full- or part-time basis to meet the needs of your organization.
HCC Medicare Advantage Coding Support
Did you know you can raise your Medicare reimbursement by as much as 20% by increasing the accuracy of your MA member coding? Our coding experts will review your medical record documentation, assess the quality for appropriateness, and assign ICD-9-CM diagnosis codes based on CMS guidelines.
RAC/Denial Management
Last year, hospitals reported $167 million worth of claims denied by Medicare’s Recovery Audit Contractors (RAC). QualCode’s denial management services will help you prepare and respond to RAC requests for clinical information—and halt RAC denials.
ICD-10-CM/PCS Coding Education and Training
Does your staff have sufficient training in the new ICD-10-CM/PCS coding system? QualCode’s AHIMA-Approved ICD-10-CM/PCD Trainers will help your staff understand the changes associated with the new coding system and learn to work with the new conventions, guidelines, and terminology.
Coding and Compliance Audits
How much are coding errors costing your healthcare facility? Cut back on unprocessed bill reports with QualCode’s knowledgeable auditing professionals, who will assess the quality of your data and identify trends and issues that are preventing your organization from achieving its maximum reimbursement potential. Note: We conclude all audits with an educational session to ensure your ongoing success.
Evaluation and Management Audits
Evaluation and management audits measure your compliance with coding and documentation requirements for E&M services, including office procedures, modifier usage, and diagnosis code that supports medical necessity and surgical procedures. The goal: to identify discrepancies that affect your bottom line.
Professional Practices
QualCode helps professional practices make sure that their documentation is clear, consistent, and complete, and that it complies with federal and state contractors like RAC, MAC, ZPIC, MIC, and HEAT. Acting as the mediator between the documentation and the claim, we will review and verify that all documentation supports what is being billed—and protect you from allegations of fraud.

Documentation and coding audits ensure that coding is accurate
Superbill Review correct CPT/HCPCS/ICD Assignment

Denial Tracking
According to industry research, the average hospital loses between $4 and $9 million each year from denials and underpayments. Yet studies also show that at least 50% of denials are recoverable—and 90% can be prevented with better workflow processes. With QualCode’s denial tracking services, you won’t have to wonder how much denials are costing your facility. We’ll help you recoup lost income and streamline your revenue cycle.