What to Expect in Due Diligence Audits & How to Find the Right Auditing Vendor

due diligence

The healthcare industry sees hundreds of facility acquisitions and mergers every year (PwC, 2020). A critical part of mergers and acquisitions is the due diligence process, which provides a complete financial and performance picture of a healthcare organization to ensure it is a sound investment. Every aspect of the facility, including the physicians, coding, property, finances, and more, are reviewed. In addition, M&A due diligence audits highlight potential liabilities and coding quality issues.

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Coding Audits: How Identifying Issues Sooner Rather than Later Saves Money for the Hospital/Facility

hospital coding audits

The establishment of a coding compliance program remains a significant effort by the Office of the Inspector General (OIG) in its attempt to engage the healthcare community in combating fraud and abuse. The OIG developed a Compliance Resource Portal with materials and guidelines for healthcare professionals. A fundamental element to an effective compliance program is conducting internal monitoring and auditing. Coding audits have the added value of ensuring you are running an efficient and profitable, not to mention minimized liability, operation. Earlier detection of any potential coding issues will pay off financially and will reduce risks for additional external audits.

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Case Study: Coding Quality Improvement Plan for Healthcare Facility Acquisition Process of a Large Physician Group

facility acquisition process

Healthcare facilities and independent practices face unique challenges when merging or being acquired. As an HIM and Coding consulting company, YES has encountered several opportunities to implement auditing, coding, and education improvement plans in similar scenarios. This case study provides a thorough analysis on the unique challenges a medical facility faces when merging with independent practices, as well as solutions for a successful facility acquisition process. Challenges impact overall medical coding quality, turnover rate, productivity and the bottom line. The analysis covers the solutions implemented, and an overview of the impact these presented to a facility, practiced over a 33-month period.

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The Importance of Specificity in Documentation and Coding HCCs

HCC specificity

As a follow-up to our previous articles on the subject of Risk Adjustment and HCCs, we now review some scenarios of HCC chronic conditions and the importance of specificity in documentation and coding. Accurate and complete documentation of chronic condition diagnoses by clinicians is an essential component of the risk adjustment and the HCC process. It is also imperative that the documentation of a disease/condition be as specific as possible. Specificity can make a difference in the patient’s treatment plans, as well as accurate code assignments, which then leads to appropriate HCC assignment and payment.

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Increase Revenue & Lower Compliance Risk With These 6 E/M Tips


Selecting the right E/M code can be tricky – and sometimes, costly – business. On the one hand, the coder does not want to choose a diagnosis that’s too high, which could potentially incur audits or claims denials. But, if the coder selects a code that’s too low, there’s a chance of losing revenue for his or her organization. According to Medical Economics, “payers and auditors use a quantitative scoring process that requires specific elements (i.e., history, exam, and medical decision-making [MDM] – or time spent counseling and coordinating care) for each E/M level” (2020).

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Top 8 Changes Medicare Payment Systems Will See In 2020

Medicare Payment Systems

The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019).

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Background & Overview of ICD-11 Before Implementation in 2022


The World Health Organization (WHO) recently released the 11th edition of the International Classification of Diseases (ICD-11). This release was presented at the World Health Assembly on May 25, 2019 for adoption by member states, and will come into effect on January 1, 2022. However, note that it is still unknown when ICD-11 will be ready for implementation in the United States.

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