Medical Coding and Auditing for Provider Groups

Provider Groups


Provider groups encounter various challenges when it comes to medical coding and auditing. The Evaluation and Management (E/M) coding guidelines are complex and involve multiple components, such as medical decision-making, history, examination, and time spent with the patient. Achieving consistency in E/M coding practices across provider groups can be challenging. Providers may have varying interpretations of the E/M guidelines and documentation requirements , leading to inconsistencies.  

Consistency is crucial for accurate reimbursement and compliance. 

Provider groups face additional challenges when it comes to procedural coding. This is due to its extensive code set, specificity, complex rules, inconsistent documentation, frequent coding changes, compliance risks, and staff training. Addressing these challenges requires continuous education, consistent documentation practices, effective auditing processes, and resource allocation for staff training and support. 

HIA offers professional fee consulting services and coding support to provider groups in the United States. HIA's credentialed coders are up to date on all E/M and CPT coding guidelines mentioned above. Our consulting service identifies specific areas of financial and compliance risk, provides pertinent information and educates clients on proper documentation, billing and coding practices. 


Our comprehensive approach

Provider Groups partner with us for:


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Single Path Coding - How do you get started?

Single Path Coding aka “dual coding” is a hot topic in our industry these days. Single Path Coding is when both the facility coding and the professional fee coding is done by the same coder, for the same patient account, and in the same workflow. Talk about efficient! Sounds like a no brainer! But how do you start? Let us tell you in our Single Path Coding White Paper.


Profee Solutions from Health Information Associates


Are your providers documenting appropriately to meet current guidelines?

Guidelines change on a frequent basis. Partner with HIA to do an initial review of your documentation and see if your physicians need further education.

Who assigns the codes at your facility?

Depending on who assigns the codes (physician, coder, or both) there may be differing areas of opportunity. Partner with HIA to determine if your coding is optimal and if you are being reimbursed appropriately.

Does your coding accurately reflect patient acuity?

Capturing the appropriate HCC codes can affect the RAF score and your overall reimbursement. HIApro reviews and assigns all relevant codes to accurately reflect the patient.  

Are you up to date on your Incident To and Shared Visit guidelines?

The CMS guidelines for Incident To and Shared Visits have been updated. Partner with HIA to ensure your coders and providers are complying with the new guidelines. 

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