From DRGs to CPTs, the healthcare industry continues to rely on coding and other reimbursement methodologies for crucial data gathering, payment and compliance. At Sinaiko, we understand the practice - and business - of medicine can be paralyzed without complete and up-to-date coding and reimbursement system knowledge and accuracy.

As such, we provide coding and reimbursement analytical services to a wide range of healthcare clients on a stand-alone basis or in conjunction with other revenue cycle, compliance or strategic projects. In addition to the expertise of nationally-recognized Certified Professional Coders, Registered Health Information Technicians, Certified Coding Specialists, and licensed Professional Medical Coding Curriculum instructors, Sinaiko offers turnkey coding services through The Coding Source, LLC, an affiliate company founded in 2002.

Clients ranging from medical groups and hospitals to payors, investors and attorneys also rely on Sinaiko to analyze payments based on the appropriate codes and payment schedules, and prepare them for updates to Medicare, Medicaid, workers` compensation and other third party payment systems. Like all of our consultants, Sinaiko`s reimbursement specialists have frontline experience in - and understand the real life application of - the recommendations they provide our clients. Many also have experience in the broader context of revenue cycle or compliance operations.  

 

Sinaiko`s Coding & Reimbursement Services:

Charge Description Master
Accuracy review of CDM descriptions and coding including UB-04 revenue codes, CPT/HCPCS codes, and modifiers. Detailed reports available, including: deleted or invalid UB-04 revenue codes & CPT/HCPCS codes, UB-04 to CPT/HCPCS code mismatching, items with zero charge amount or zero volume.  Corrective action implementation and integration with other related revenue cycle functions.

Professional Documentation and Coding
Auditing, training for physicians and internal coders, independent review organization (“IRO”) services,  litigation support, and due diligence.

MS-DRG (severity driven) Concurrent Documentation Improvement Program (CDI)
Proprietary documentation improvement program and tools, including a seven-step plan for optimizing reimbursement opportunities under Medicare's Inpatient Prospective Payment System by appropriately capturing severity levels for each Medicare inpatient admission. Auditing, assessment, training and implementation focused on identifying documentation and coding improvement needs based on specific clinical indicators for various types of admissions.

RAC Audit Preparedness 
Identification of the key risk areas within audits and denials to aid in self-assessment, establish best practices in preparation for RAC, assess claim readiness, identify potential denials, and develop a customized concurrent documentation improvement (CDI) program.
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Clinical Laboratory Assistance
Assessment, auditing and compliance consulting for outpatient, hospital, referral and specialty labs.

Home Health and Durable Medical Equipment Suppliers
Compliance assessment and auditing services designed to identify potential risk areas and implement compliance improvement programs. Projects often include close collaboration with client legal counsel.

For more information about Sinaiko`s Reimbursement Services, please contact Michael Sullivan at michael.sullivan@sinaiko.com.