Advisory
From implementation through execution, Torres-Lich Advisory practice helps clients build and keep their competitive advantage and leverage profitable income.
Services
Services Overview
Torres-Lich and Associates offers a variety of services covering almost every need of modern
medical billing and compliance. Our most popular services are below.
Coding & Documentation
Our outpatient coding and compliance audits help support your HIM coding compliance efforts through extensive data quality monitoring from an objective third party viewpoint. Our specialists will assess your coding staff’s accuracy and educational needs by the review of a pre-determined number of cases/encounters for appropriate code assignment, supporting documentation and regulatory compliance. The audit will be conducted utilizing the guidelines for coding and reporting that have been developed by the cooperating parties for ICD-10-CM (i.e., coding clinic, etc.), and the centers for Medicare and Medicaid Services for CPT/HCPCS Level II. Our specialist will review findings with your coders to review and discuss discrepancies. A detailed report summarizing the findings and providing recommendations will be utilized to identify areas of improvement and establish objectives for corrective measures. Our coding and documentation assessment audits services include Retrospective Reviews (Post-Bill) and Concurrent Reviews (Pre-Bill).
Denials Management
Our specialists will assist your organization with developing a proactive approach to denials management by assessing your organizations denial management process to ensure that the denials management team, clinical documentation integrity (CDI) and coding teams are all involved in the review and applicable appeal processes. We will review total denials received, total denials appealed versus those not appealed and the rationale why. In addition, we will review the total cases overturned and the associated financial impact, second-level denials, and failed appeals.
Chargemaster
An important component of denials management is the review of the Chargemaster. Our specialist will review your facility’s Charge Description Master (CDM)/ Chargemaster to ensure that the CPT/HCPCS codes, supplies and revenue codes are current, accurate and reflective of the services performed. As part of the process, we will conduct on-site interviews with your clinical and non-clinical departments to gain an understanding of how they bill/charge for their services and to review individual department line items so that all new, revised, and deleted codes are appropriately represented within the Chargemaster to ensure proper payment. In addition, we will assist your organization with refining your charge capture process and ensure charges match up with the procedures/services performed.
Education
Coding and documentation are subjected to a substantial amount of scrutiny from both federal/state governmental payers and commercial payers. As a result, specific expertise is required to support the documentation and coding process. Our coding and documentation educators have over 25 years of experience in providing coder education for RHIA, RHIT and CCS/CCS-P Coding programs as well as in a variety of venues including hospitals, medical practices, and insurance companies, etc.
Training
We are committed to assisting you with developing and cultivating your current and future coding, billing and claims/denial review staff through coding and billing education and mentoring. Our educators can assist you with developing in-service programs to address coder and biller deficiencies or assist coders, billers, and claims/denials reviewers with keeping abreast of current coding/billing protocols and regulatory requirements. In addition, we provide coding, billing and claims/denials review education and training programs that include and that are not limited to ICD-10-CM, HCPCS Coding systems, Claims Processing and Denials Management and regulatory compliance.
Witness & Claims Review
We offer healthcare providers, insurance companies, and attorneys with coding, documentation, and billing consultation services and applicable expert opinion testimony on a wide variety of documentation, coding, billing, claims and denial management services. Other areas of consultation include Diagnostic Coding (ICD-9-CM/ICD- 10-CM), Inpatient services, Outpatient services, Revenue Cycle, Health Care Compliance, and HIPAA, etc. Our associates include credentialed Health Information Management Professionals with many years of experience working in and with Coding, Billing, Auditing, Managing Health Information Management Departments, Corporate Compliance, and Revenue Cycle with various health care settings such as hospitals, ambulatory surgery centers, mental health facilities, and physician practices.