Clinical Coding Compliance
Our Solutions and Services
The transition to Diagnosis-Related Groups requires a total overhaul of hospital revenue cycles, clinical documentation, and billing setups. 3C Health offers end-to-end strategic guidance to ensure your hospital is ready on Day 1.
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DRG Gap Analysis:Â Comprehensive audit of your current EHR, billing structures, and coding workflows to identify points of failure.
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Case Mix Index (CMI) Baselining: Analyzing historical coding to establish your hospital’s baseline CMI.
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PLICS Integration Consulting:Â Helping finance and IT teams align Patient-Level Information Costing Systems with DRG clinical parameters.
DRG Readiness Advisory
Clinical Coding & Audit
Our auditing services identify potential deficiencies, prevent downcoding penalties, and guarantee coding compliance.
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Pre-bill Clinical Coding Audits:Â Routine audits of clinical charts before claims submission to verify documentation matches the assigned ICD-10-AM, ACHI and SBS codes.
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Retrospective Coding Audits:Â Deep-dive reviews of historical claims to identify systemic under-coding (lost revenue) or over-coding (compliance audit risk).
Clinical Documentation Improvement & Training Programs
Our CDI programs are designed by clinicians for clinicians, translating abstract coding requirements into natural, precise clinical documentation habits.
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Peer-to-Peer Coaching:Â Respectful, clinician-led training showing doctors how specific terms affect coding outcomes.
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TTT-Enabled Educational Programs:Â Custom-built training regimens utilizing certified Training the Trainers methodologies empowering internal staff to lead the transformation.
RCM & Insurance Payer Advisory
Our insurance and strategy experts align your billing, costing, and dispute workflows with DRG realities.
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DRG Denials Management:Â Identifying the root clinical or administrative causes of insurer rejections and drafting robust, evidence-backed appeal letters.
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Payer Contract Strategy:Â Helping hospital boards evaluate and negotiate payer contracts under new DRG costing structures.
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Pre-authorization Workflow Audits:Â Streamlining clinical pathways to secure faster pre-approvals under DRG regulations and standards.
Who we serve
Private Healthcare Systems & Hospitals
Medical Centers & Specialized Clinics
Health Insurance Companies & Payers
Government & Semi-Government Entities
Comprehensive auditing and coding programs to protect operating margins and ensure audit readiness.
Targeted documentation and billing alignment for outpatient operations and specialized medical surgical facilities.
Independent clinical audit oversight, utilization reviews, and third-party claims validation.
Strategic advisory for health sector transformation, quality indicator frameworks, and governance compliance.