Profee Coding and Review Services

Profee Solutions

Here at HIA, we understand the value of supporting physician practices, and HIApro focuses on just that. HIApro is a professional fee consulting service. Our service identifies specific areas of risk, provides pertinent information and educates clients on proper coding, billing and documentation practices. Our main objective is to build long-lasting relationships with physician practices.  

PROFEE CODING
PROFEE REVIEW

WHO WE WORK WITH

Markets we serve

Hospitals

Accurate coding of inpatient & outpatient services is a crucial element in a healthy reimbursement and compliance strategy.  Partner with HIA to replace underperforming coding vendors or to provide comprehensive medical coding reviews.

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Physician Groups

Physicians and mid-level providers, both employed and independent, continue to face financial and compliance related challenges. Partner with HIApro for all of your professional fee consulting needs. 

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Ambulatory Surgery Centers

Rarely does an ASC have the luxury of a dedicated coding manager, much less an educator and internal auditor. HIA’s service is aimed at providing a reliable resource to address all three important functions and more. 

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Behavioral Health

Behavioral health related services are on the rise in the United States with around 20 million Americans experiencing a mental health illness. HIA can address your coding and reimbursement needs for both the facility and the provider. 

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Critical Access Hospitals

HIA has developed a package exclusively for CAHs that addresses common coding challenges – all for one, budget-friendly,  fixed annual fee.  

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Urgent Care

HIA partners with Urgent Care facilities to ensure their coders and providers are following all of the updated coding guidelines.

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Rehabilitation Centers

HIA partners with Rehabilitation Centers to ensure their procedure and diagnosis coding is complete and accurate. 

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Rural Health Clinics

HIA employs coders and consultants who are specialized in coding for Rural Health Clinics and understand the unique RHC guidelines. 

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Home Health

HIA has taken a team-based, consultative approach to home health and hospice medical coding and reviews. When you work with us, you get the whole team

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WHAT WE OFFER

Our niche solutions

Total Outsource Coding Support

Today's healthcare environment is already challenging enough. Let us help you achieve:

  • Guaranteed staffing
  • Appropriate and timely reimbursement
  • Representative quality measures
  • Improved CMI
  • Reduction in payer denials
  • Mitigation of compliance risks

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Single Path Coding

Whether you are considering, or in the process, or have implemented Single Path Coding, we're here to help. Our clients have seen:

  • Increases in overall productivity and accuracy
  • Decreases in claims denials
  • Significant reduction in operational costs

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Interim Auditing

We provide experienced coding consultants when you need them most: 

  • One-on-one coder development/improvement
  • Address surging payer denial/appeal volumes
  • Assess coding's role in CMI fluctuations
  • Investigate skewed quality metrics
  • Supplement internal staff for focused auditing (DRGs/Dx, mortality, PSIs, monthly coder reviews, etc.)
  • Manage and resolve billing edits

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Rev Cycle Management

HIA’s Revenue Cycle Management service can assist your organization in one or a combination of the following:

  • CMI impact - CC/MCC capture
  • Billing edit resolution
  • Focused DRG audits
  • CDI audits
  • Claims denial audits/Appeal support  

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Denial Management

HIA’s Denial Management service will assist your organization in one or a combination of the following: 

  • Review applicable denied and/or rejected claims 
  • Determine if an appeal is warranted 
  • Facilitate appeal process including authoring of appeal letter, tracking and adjudication  
  • Analysis of denials and operations assessment to determine root causes. 
  • Corrective action recommendations, education to applicable stakeholders 

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Case Mix Index

Are your coders capturing all CC/MCCs? If not, it could be negatively affecting your CMI and quality measures. In addition to reviewing CC/MCC code selections for both medical and surgical MS-DRGs, we:

  • Investigate cases where there is a single reporting of a CC or MCC in a given time period as this can indicate a coding error or a provider documentation opportunity.
  • Review a sudden spike or unusually high volume of MS-DRGs with CC/MCCs as this can be an indicator or an increased denial risk and can impact mortality index reporting.
  • Evaluate outliers in the average length of stay where inconsistencies can identify coding and documentation opportunities.

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