Determining accurate codes for diagnoses, procedures and services performed by physicians and recognized, licensed nonphysician providers in physician-based settings (These services may include evaluation and management services as well as reviewing operative notes)

Keeping current with medical compliance and reimbursement policies, such as medical necessity issues and correct coding issues

Performing various auditing duties related to physician practice management and coding to maintain compliance with payor reimbursement policies and governmental regulations as well as Medicare/CMS guidelines

Monitoring progress resulting from periodic internal audits

Providing training in coding and compliance issues to physicians, nonphysician providers and staff on an ongoig basis

Providing physicians and staff with up-to-date coding information from reliable, accurate sources, such as specific payors, the AMA, AHA’s Coding Clinic, and CMS, to name a few

Providing orientation training to include medical practice guidelines for new physicians and non-providers to the practice

Implementing of new coding guidelines in a timely manner within the practice

Updating encounter forms/superbills on an annual basis with respect to diagnostic, procedural and supply code changes

Updating other patient information forms as necessary from time to time

Updating the clinic’s fee schedule based on Relative Value Unit (RVU) updates that come out annually and based on additions and deletions to codes for procedures, services, and supplies

Preparing and/or submitting completed HCFA-1500 forms for services and procedures performed by the practice’s physicians and nonphysician providers, such as CRNAs, nurse practitioners and physician assistants

Reviewing explanations of benefits from payors, evaluating denied claims and filing appeals for denied claims