Medical Billing Companies & Consultants in Amherst, OH

Coding & Compliance Experts, LLC is a healthcare administrative support firm based in Amherst, Ohio, near Lorain. It has been in operation since 2009. Its work centers on the revenue-cycle and regulatory tasks that come before and around claims: getting providers credentialed with insurance carriers, checking coding and documentation, and building compliance programs. It does not handle day-to-day claim submission.

Instead, it takes care of the groundwork that lets a practice bill payers and keep that revenue. The firm works with healthcare organizations anywhere in the United States, and it handles credentialing and provider enrollment in all 50 states.

Who They Serve

Its clients include individual healthcare providers, urgent care clinics, medical groups, hospital groups and hospital systems. The firm also supports behavioral health practices, home health agencies and durable medical equipment suppliers. It works with both new practices that are just opening and established clinics that want to hand off administrative work.

Services Offered

The firm's services fall into three main areas: credentialing, coding and documentation review, and compliance:

• Insurance credentialing, provider enrollment and ongoing credentialing maintenance
• Medicare and Medicaid enrollment, plus CAQH registration
• State medical license applications and renewals, CLIA applications, and DEA and CDS registrations
• Clinical documentation audits
• Physician billing and coding training
• Setting up compliance programs, reviewing how well they work, and acting as a concierge compliance officer
• Clinic risk assessments, done onsite or remotely
• Monthly employee exclusion screening
• Yearly HIPAA privacy and security training and OSHA training
• Help starting a medical office, including job descriptions and custom patient handbooks

How They Work

The firm presents credentialing as a direct driver of revenue. A provider who is not properly enrolled with a payer can wait weeks or months to be paid, or may be left out of a network altogether. Its goal is to get applications right on the first submission so these delays don't happen.

Training can be delivered at the client's location or online. Risk assessments are also offered in either format. Clients exchange documents through a secure ShareFile client portal. The firm also sends out a monthly compliance newsletter so practices can keep up with changes to state and federal rules.

Background and Team

Michelle Ann Richards founded the company and still owns it. She has worked in healthcare since 1992. She has a degree in health care administration and holds three certifications: Certified Professional Coder, Certified Compliance Officer and Certified Professional Medical Auditor. She belongs to MGMA and AAPC, and she helped develop the curriculum for AAPC's CPCO course. The rest of the team includes a credentialing lead, several credentialing specialists and a human resources specialist with an MBA and SPHR certification.

For buyers comparing medical billing vendors, this firm is best suited to practices that need credentialing, payer enrollment, coding audits or compliance oversight, rather than outsourced claims processing. Its main strengths are nationwide enrollment coverage and its owner's coding and auditing credentials.