Provider and payer coding
Coding support for risk adjustment, documentation integrity, facility and professional work, and home health.
ForeMed supports medical coding for healthcare providers and for payers. The scope is the set of coding types below, agreed encounter by encounter in a statement of work.
Coders work in the systems and guidelines you specify. We do not promise a risk score, a case-mix change, or a revenue result. The deliverable is coding that the record supports, with a sample you can audit.
01
Risk adjustment coding for HCC in the four modes named by ForeMed: concurrent, retrospective, prospective, and pre-visit.
The task is to capture conditions the documentation supports and to leave out conditions it does not. A mode is chosen per engagement. We do not treat prospective or pre-visit work as a licence to code what has not been documented.
02
Clinical documentation integrity for risk adjustment sits beside the coding. We support reviews and queries that ask the author of the record to clarify a condition that appears to be present.
Query language follows your CDI policy. A query is not a code, and a code is not added because a query was sent.
03
Emergency department coding for both the professional-fee component and the facility component.
Evaluation and management, procedures, and diagnoses are coded to the guideline set you name. Facility and professional work can be scoped together or separately.
04
Coding review where a denial turns on code selection, a modifier, or diagnosis linkage.
A recommended change is written down with the documentation that supports it. If the record does not support a change, we say so.
05
Evaluation and management coding for inpatient and outpatient encounters, against the guideline version you specify.
Inpatient and outpatient work are scoped separately when the guideline, the template, or the reviewer is different.
06
Radiology coding for the professional and technical components your engagement includes.
Pathology is paired with radiology in ForeMed’s specialty list. Coding for that pair is scoped to the reports you send.
07
Coding for same-day surgery encounters, including the procedure and diagnosis coding an ambulatory case requires.
Implant, device, and supply questions are returned when they are outside the coding decision.
08
Inpatient coding that supports DRG assignment: principal diagnosis, procedures, and the complications and comorbidities the chart documents.
We code what the record supports. We do not target a DRG.
09
Home health coding is one of the five areas of expertise named by ForeMed, alongside risk adjustment, HIM, CDI, and revenue cycle management.
Diagnosis and encounter coding is scoped to the home health records you provide.
10
Coding is offered to providers and to payers. The same coding types can be scoped either way.
A payer engagement and a provider engagement use different work instructions. We do not reuse one client’s rules on another’s charts.
11
HIM support around the coding workflow: questions of record completeness, coding-related edits, and handoff into the revenue cycle.
This is support for the coding operation. It is not a claim to staff a hospital health-information department.
01
Charts, specialties, payers, guideline version, and the system you already use. We agree what is in scope and what is returned.
02
A written instruction and a sample set. Production starts after the instruction is signed off.
03
Coding against the instruction. Items that need a clinician or a biller are sent back with a reason, not a guess.
04
A dedicated quality team reviews a daily audit sample of 3–5%, with SOP sign-off and calibration when reviewers disagree.
ForeMed’s coding quality practice is a dedicated quality team, a daily audit sample of 3–5%, SOP sign-off, and calibration.
The sample rate is a review practice. It is not an accuracy rate, and it is not a promise that unsampled charts are error-free.
Quality findings are yours to inspect. We do not summarise them as a marketing percentage.
Any of the types on this page: HCC in one or more of the four modes, risk adjustment CDI, emergency department, denials, evaluation and management, radiology, same-day surgery, inpatient DRG, or home health. Payer and provider work are both in scope.
No. Coding reflects the documentation. Risk scores and DRG assignment are downstream of the codes the record supports.
A dedicated quality team reviews a daily sample of 3–5% of production, with SOP sign-off and calibration. You can ask to see the sample method.
Yours. The guideline version, payer edits, and facility rules are part of the work instruction before production starts.
Other service lines
Next step
Name the setting, the volume, and which part of this page you want. We will scope from that, not from a standard package.