Federal Management Systems
Federal Management Systems

Medical coding is a vital part of the revenue cycle process which, if inaccurate, can lead to delayed claim submission and loss of revenue. Hence, payer practices such as denials or down coding—that payers often rely on in order to deny payment—need to be addressed with a higher level of expertise to assure appropriate documentation, well-managed denials and appeals, and evaluation of the accuracy of codes that are billed.

“Reducing downcodes is achieved by real-time identification of documentation omissions that affect charging and, in many instances, appropriate recording of patient care,” says Caral Edelberg, the CEO of Edelberg + Associates, a company that brings unique processes for coding, practice evaluation, auditing, and provider education.

The company is committed to helping thousands of medical providers navigate the complex and ever-evolving medical coding and compliance landscapes. “The medical industry has the data at its disposal to provide insights that can significantly improve coding and compliance accuracy, which positively impacts our clients’ bottom line, and we are excited to be on the leading edge of data analytics within our industry,” adds Caral.

Backed by highly trained and experienced coding professionals, the company carries out end-to-end review through patient logs, provider records, documentation assessment, deficiency tracking, and internal auditing, which significantly decreases lost revenue and streamlines the workflow for the entire hospital chain.

The company extends a wide range of coding-related services, including denials management and quality assessment. Through E+A’s proprietary online coding and quality assurance auditing software, the firm identifies documentation and coding errors. The education management team of Edelberg + Associates then consults with the providers to eliminate these errors along with the compliance risk associated with them in order to maximize revenue appropriately.

Edelberg + Associates is revolutionizing the medical coding landscape with robust tools designed to reduce risk and compliantly maximize revenue

Not just that, the company also offers groundbreaking online coding and documentation education programs. “We actually educate the providers individually on the problems that we find and wrap all the solutions into one package for them,” says Edelberg.

One of the things that make Edelberg + Associates stand out is their proprietary CARE Coding Platform. “CARE” (Coding, Audit, Reporting and Education) assures that all needs are met. In just a few clicks, the coding platform reveals real-time status of the coding, patient volume, acuity, number of suspends, and downcodes. “As an audit or coding program progresses, we manage the data while our customers view reports to get insights into what we are doing,” says Edelberg.

Commenting on a project where the company had to revise the medical coding for a healthcare organization, Caral says, “No matter how good a service provider and how efficient their documentation process its medical coding can never be complete without accurate and up-to-date medical charts and a documentation accountability process.” In this instance, the healthcare organization had outsourced their coding process to a reputed provider, but many errors persisted in their medical coding and provider documentation. They turned to Edelberg + Associates. After a comprehensive analysis of every step followed in the documentation and coding process, Edelberg + Associates found that many of the records were outdated, and a large set of information was fraught with omissions and/or inaccuracies. Consequently, the development team of Edelberg + Associates started from scratch and built a process that accounted for every medical record in the organization. The hospital staff was quick to get on board and assisted the team in rectifying the information. This was made possible by establishing robust feedback loops and collaborating with the management teams. Five years later, the healthcare organization reported a significant and compliant increase in revenue, minimal provider downcodes and up-to-date coding processes having entrusted Edelberg + Associates with numerous other systems.

This is just one of the many success stories crafted by the team at Edelberg + Associates, and the secret lies not only in their ability to work hand in hand with clients, but also in its versatility. Backed by over 40 years of industry expertise and a skilled workforce with a substantial background in medical coding and medical practice management, the company seeks to raise the standard of patient care. The next step for Edelberg + Associates is employing artificial intelligence (AI) and big data to augment their offerings and empower the clients.