Specifications include, but are not limited to: The purpose of this RFP is to secure services to: • Advise on best practices with respect to prospective and retrospective coding and billing compliance audits. • Practice the accuracy and integrity of coding in accordance with International Classification of Diseases-10-Clinical/Modification/Procedure Coding System’s (ICD-10-CM/PCS) Official Guidelines for Coding & Reporting, Current Procedural Technology (CPT) Guidelines, American Hospital Association (AHA) Coding Clinic, CPT Assistant, Centers for Medicare and Medicaid rules and regulations, as well as Federally Qualified Health Center (FQHC) specific coding and abstracting guidelines. • Train on the processes to ensure that all pertinent diagnoses and procedures have been appropriately captured by the provider for medical necessity and coding compliance purposes. • Help to identify documentation issues that could impact revenue, coding compliance, and/or quality reporting data. • Evaluate the providers on accuracy on a coder specific basis and identify any areas for educational improvement. • Identify provider documentation improvement opportunities on a provider specific basis and identify any areas for educational improvement. • Provide targeted and general education to providers to review findings and/or provide education related to the audit findings.
