About Coding Continuum

Coding Continuum, Inc. is a nationally recognized consulting firm based in Tucson, Arizona.  Founded in 2000 by a health information management professional, Coding Continuum, Inc. provides a variety of services, including detailed medical coding and billing compliance reviews/audits, operational assessments/internal investigations, education, and other client-requested services.

In addition to its work for the provider community, Coding Continuum, Inc. provides litigation support services. It represents both defendants and plaintiffs in matters pertaining to allegations of improper medical coding and/or billing. Its experts have been qualified in both civil and criminal court. Coding Continuum, Inc. clients also include the Department of Justice (including offices of the United States Attorney and Federal Bureau of Investigation), some of the largest insurance carriers in the United States, and nationally-recognized law firms.  In addition to its work for the Department of Justice, Coding Continuum, Inc. has also been retained as an Independent Review Organization (“IRO”) by a number of clients who are operating under Corporate Integrity Agreements (“CIA”) pursuant to settlements with the Office of Inspector General (“OIG”).

Coding Continuum, Inc.’s primary goal and interest is to support clients whose needs are specific to the discipline of health information management in the context of medical coding, billing, operations, compliance and revenue cycle administration.  The majority of Coding Continuum, Inc. Senior Consultants have a minimum of twenty years of operational experience in their respective areas of expertise, including direct responsibility for process improvement in high volume, highly complex healthcare facilities.  They include academic medical centers with Level I Trauma services (including Pediatric/Neonatal Intensive Care units), community hospitals, NCI cancer centers, psychiatric/behavioral health services, subspecialty surgical services, SNFs, IRFs, LTACs, home health, hospital-based and freestanding outpatient clinics, small/large practice groups, and other settings.

Coding Continuum, Inc.’s coding/auditing consultants have extensive experience evaluating the accuracy of ICD-9-CM, CPT® (including E/M coding), HCPCS, and modifier use.  They are well acquainted with coding rules and conventions as well as guidelines regarding proper use of specific nomenclatures, reimbursement methodologies such as MS-DRGs, CMGs, and Federal/State claims submission requirements.  A number of consultants possess the CPC-I credential accorded by the American Academy of Professional Coders.  The credential requires instructors to pass a written and oral examination prior to being accorded the credential which allows them to teach the AAPC Professional Medical Coding Curriculum.  The majority of Coding Continuum, Inc.’s coding experts are dually-credentialed by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).

In addition to its group of skilled coding professionals, Coding Continuum, Inc. employs clinical and administrative experts, including nurses, physical and respiratory therapists, clinical documentation specialists, health information management professionals, reimbursement experts, cost report experts, and contracting experts.  Coding Continuum, Inc. also enjoys a collaborative relationship with a physician-based firm specializing in medico-legal analysis.  This affords our clients a single source solution for its coding, billing and medical expert needs.

Prospective Payment and Medical Necessity Expertise

As referenced above, Coding Continuum, Inc. consultants possess years of experience applying various coding nomenclatures, including those which are critical to proper assignment of MS-DRGs, MS-LTC-DRGs, RUGs, CMGs, APCs, and others.  Knowledge of ICD-9-CM coding rules and conventions as well as ICD-9-CM published guidelines is the most critical factor in determining the accuracy of prospective payment system billing such as MS-DRGs, MS-LTC-DRGs and CMGs. Coding Continuum, Inc. has performed many audits whose focus has been acute and long term inpatient hospital care, independent rehabilitation and skilled care.  The majority of audits have been provided in the context of litigation support involving civil or criminal investigations.

In addition to its work related to proper coding and grouping, Coding Continuum, Inc. has been retained by both plaintiffs and defendants in matters related to evaluation of medical necessity.  Application of both InterQual and Milliman and Robertson screening criteria has been a component of its work as well as application of payer-specific guidance regarding medical necessity. Coding Continuum, Inc. clients also include providers who wish to evaluate the propriety of inpatient and outpatient care delivery as part of internal compliance program initiatives and process improvement projects.

 

  • Areas of Expertise / Experience

    • Medicare/Medicaid Fraud
    • Commercial/Self-funded Plan Fraud
    • Forensic Audits
    • ICD-9-CM & CPT® Coding
    • E & M Coding
    • Prospective Payment Systems Reviews
    • Medical Necessity Reviews
    • Operational Assessments
    • Investigations
    • Document Analysis
    • Medical Record Review
    • Medicare Cost Reports
    • Cost/Charge Analysis
    • Education

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