Edelberg and Associates
Revolutionizing the Medical Coding Landscape

Medical coding has become an extremely complicated process as payers progress toward individualized coding policies for their organizations leaving behind traditional models such as the Medicare and CPT guidelines. As a result, every payer requires individualized management focus to assure codes comply with guidelines that differ from one payer to another. However, due to the lack of skilled coders and incorrect coding practices, payers in the healthcare space are facing compliance issues, reduced reimbursement, and increased audits and denials. What organizations need is a robust platform that not only provides well-constructed process-driven solutions but also educates coders while keeping consistent checks and balances on coders and providers to assure compliance and revenue. Enter Edelberg and Associates (E+A).

Having been in the industry for over 40 years and counting, E+A is at the forefront of offering groundbreaking in-house medical coding products that combine sophisticated analytics, process discipline, and educational initiatives to ensure that the challenges associated with risk, regulation, and revenue are addressed. With the help of E+A’s innovative coding software, the company is able to identify risks by assessing coding errors and documentation omissions while providing deep-dive reporting and feedback—an often overlooked element in the medical business process.

As the coding rules and electronic medical records have become extremely difficult to comprehend, providers spend more time documenting various payer requirements, which is not only time-consuming but also impacts revenue. To address this intricacy, “we developed our web-based education suite that allows providers and coders to access the learning materials on their own time while we remotely track their progress and results,” says Caral Edelberg, founder and chairman of Edelberg and Associates.

The company’s proprietary software and its ability to report on all phases of coding and provider resources have made them second to none. “Our dashboards allow our clients to track everything related to our processes and their revenue minute-by-minute,” says Edelberg. E+A’s onboarding process allows the company to take a deep dive into its clients’ systems, processes and needs, and affect solutions well in advance of “Go Live” which assures a smooth onboarding process. “It also allows us to “Get Acquainted” with client representatives and providers and to build a long-term relationship with the clients if all goes according to plan,” says Edelberg. It’s where the relationship begins and demands E+A’s best resources to build the interface, processes, and data requirements unique to each client location.

Another area where E+A has gained recognition for is its audit service, which allows the company to identify areas that need additional education, clarification, and support. It helps the company build rapport and a relationship based on trust and credibility, both critically necessary for a successful partnership. E+A keeps a close watch on data from its audits for coding and documentation patterns to help identify any client risk from inaccurate coding as well as missed financial opportunities that result from poor or incomplete documentation, lost records, and coding errors.

“One of the key successes started with one academic practice that saw tremendous benefit from our systems— so much so that they moved us into other hospitals in the hospital system and incorporated our system into their affiliated systems and numerous medical practices,” elaborates Edelberg. So, in effect, currently both physicians and the hospital technical services are managed by E+A.

As E+A sets out for more successful ventures, its immediate plans include branching out into all medical specialties while increasing its educational offerings for different providers. E+A will move toward building payer related databases, which helps it to proactively manage the potential denials problems and prepare for appeals. E+A is also keen on building an inpatient coding process, which would complete its suite of outpatient professional and technical coding performance offerings. “With our evolution as a multi-specialty coding vendor facilitated by our provider and coder education suite, we are well-positioned to shape a new horizon for the medical coding arena,” concludes Edelberg.