| Coding Continuum, Inc. provides litigation support in matters involving coding, billing and reimbursement of medical claims. CCI professionals are experienced in interpretation and application of Federal, State, and private payer guidelines as well as assessment and evaluation of provider-payer issues, including allegations of inaccurate coding of claims, fraudulent claims submission, and improper billing practices. CCI provides expert testimony in cases involving Federal and private third party payers. Our team includes Registered Health Information Administrators, Registered Health Information Technicians, Certified Coding Specialists, Certified Professional Coders, Licensed Professional Medical Coding Curriculum Instructors, Nurses, and specialists in billing, quality improvement, and utilization review. |
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Case Studies
A hospital filed suit to recoup alleged DRG underpayments. Coding Continuum, Inc. was retained to ascertain whether the hospital's allegations had merit. Coding Continuum, Inc. professionals reviewed a large number of hospital admissions to determine quality/validity of ICD-9-CM coding and DRG grouping. CCI personnel re-coded and re-grouped each case, completing detailed individual case abstracts. A comprehensive summary of findings was submitted with a written analysis. In addition, one-day stays were reviewed to determine appropriateness of admission based upon InterQual Intensity of Service/Severity of Illness criteria.
A group of radiation oncology providers filed suit against a nationally recognized payer, alleging inappropriate clipping of payments. The case was critical because of its "test case" status and attendant implications for providers and payers statewide. Coding Continuum, Inc. professionals reviewed contract materials, provider manuals, and legal briefs associated with the case. Expert witness testimony was provided by CCI regarding protocols for accurate coding and billing of specific radiation oncology services.
A large hospital system filed suit against an insurer alleging underpayments for Neonatal Intensive Care Unit and Cardiac Care Unit cases. Coding Continuum, Inc. personnel reviewed claims data, provider manuals, plaintiff expert witness reports, and contracts associated with the case. Research and expert witness testimony was provided by CCI personnel regarding appropriate revenue code usage for Neonatal Intensive Care Unit claims submission and levels of care for NICU and CCU patients.
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