Question 1

What specialties does Edelberg & Associates code for?

Accepted Answer

We specialize in emergency medicine, freestanding ED, urgent care, hospital medicine, and observation medicine coding, including both professional and facility billing. We also serve anesthesia, behavioral health, and selected surgical specialties. Our medical coding researchers are trained specifically in the nuances of each specialty, including payer-specific documentation expectations that directly affect reimbursement. This depth of specialization is why our clients see fewer denials and faster clean-claim rates than with general coding vendors.

Question 2

Do you offer short-term or supplemental coding support?

Accepted Answer

Yes. We work with organizations on long-term partnerships, short-term project engagements, and team augmentation for capacity gaps, vacancies, or volume spikes. Our onboarding process is designed to get supplemental coders integrated into your workflow with minimal disruption, typically within one to two weeks. We have supported groups ranging from a single-provider urgent care to large multi-site emergency physician groups. Whatever your capacity challenge, we can scale to fit.

Question 3

How do you guarantee coding accuracy?

Accepted Answer

Every coded encounter goes through a structured internal QA process before submission, and our accuracy rate consistently exceeds 95%. Our C.A.R.E. platform gives your team real-time visibility into production volume, coder queues, and quality metrics so you are never left guessing. When accuracy trends shift, we investigate the root cause immediately, whether that is a documentation pattern, a payer policy change, or a coder training gap. Transparency and accountability are built into every engagement.

Question 4

What is AI medical coding validation?

Accepted Answer

AI medical coding validation is a prospective review process where our expert coders check AI-generated codes against clinical documentation before claims are submitted. AI tools are improving rapidly but they make systematic errors, misreading documentation context, applying outdated payer rules, or missing facility-specific coding requirements. Our validation layer catches those errors before they become denials, protecting your revenue without slowing down your workflow. Think of us as the human expert layer that makes AI adoption safe.

Question 5

Do you work with all AI coding tools?

Accepted Answer

Yes. Our validation process is entirely tool-agnostic, whether you use a major EHR-integrated AI coder, a stand-alone third-party platform, or an internally developed solution. We validate AI output against the clinical documentation, applicable CPT and ICD-10 guidelines, and payer-specific policies that govern reimbursement in your market. Our goal is not to replace your AI investment but to make it defensible and accurate enough to trust at scale.

Question 6

How long does AI validation onboarding take?

Accepted Answer

Most engagements are operational within two to three weeks from signed agreement to live workflow. We spend that time integrating with your systems, understanding your volume and payer mix, and aligning on quality benchmarks. Our team handles the technical coordination so your internal staff can focus on patient care. Book a free consultation and we will scope your specific timeline based on your volume and setup.

Question 7

Can Edelberg serve as an expert witness in a payer dispute?

Accepted Answer

Yes. Our team has provided expert testimony in legal proceedings against major national payers, and in every case we have been part of, we have prevailed. We prepare thorough documentation, analyze the coding record in full, and present findings clearly for legal and non-clinical audiences. Our credentialed experts understand both the clinical and regulatory dimensions of payer disputes, which is what makes the difference in contested cases. If you are facing an audit, appeal, or litigation, contact us before you respond.

Question 8

What causes most claim denials in emergency medicine?

Accepted Answer

The most common denial drivers in emergency medicine include payer downcoding on higher E/M levels, medical necessity disputes, and documentation deficiencies that fail to accurately describe the services rendered. Borderline documentation is a frequent trigger. Common examples include failure to document the review of diagnostic tests, absence of risk stratification in clinical notes, and vague or loosely defined diagnosis statements where acuity and risk are not clearly addressed. Non-specified diagnoses that cannot be coded accurately due to insufficient clinical detail represent one of the largest denial categories we manage. Payers increasingly use automated review engines that flag claims based on statistical outliers rather than individual clinical judgment, which creates systematic denial patterns that require expert analysis to identify and challenge. We review your denial data to pinpoint the specific root causes in your group, then develop a targeted response strategy that includes provider education, appeal templates, and documentation improvement protocols.

Question 9

Do you work on a contingency basis?

Accepted Answer

Engagement structures vary depending on the scope, complexity, and nature of the dispute. We are flexible and have worked with physician groups, hospital systems, and healthcare attorneys under a range of arrangements. Contact us to describe your situation and we will be straightforward about what makes sense for your case. Every organization is different and we would rather find the right structure than force a standard contract that does not fit.

Question 10

What does a compliance audit from Edelberg include?

Accepted Answer

Our audits review coding accuracy, documentation alignment, payer policy compliance, and billing practices across a statistically significant sample of encounters. We use analytic tools to determine audit volume and exact chart identification, ensuring samples are randomly selected and evaluated against both coding standards and contracted payer rules. You receive a detailed written report with findings organized by risk level, specific examples from the record, and prioritized corrective action recommendations. We also conduct a debrief session with your leadership and clinical team to walk through the findings and answer questions. The goal is not just to identify risk. It is to leave your organization in a measurably better compliance posture.

Question 11

How often should we conduct a coding audit?

Accepted Answer

Best practice for high-volume specialties like emergency medicine is quarterly auditing, which allows you to catch drift before it compounds into systemic risk. At minimum, annual audits are strongly recommended for any organization submitting claims to Medicare, Medicaid, or commercial payers. The frequency should increase whenever you adopt new coding systems, hire new coders, onboard AI coding tools, or receive an external payer audit. Proactive auditing is always cheaper than reactive remediation.

Question 12

Can Edelberg help us respond to a payer audit?

Accepted Answer

Yes. We assist with audit response documentation, appeal letter development, and preparation for payer meetings at every stage of the process. Our team reviews the payer's findings against the actual clinical record, identifies where their methodology is flawed or inconsistent, and builds a factual, well-documented rebuttal. If the dispute escalates to legal proceedings, we also support counsel with expert analysis and testimony. Early engagement gives us the most options, so contact us as soon as you receive an audit notice.

Question 13

What is the C.A.R.E. platform?

Accepted Answer

C.A.R.E. is proprietary software built specifically to empower your coding and auditing operations, covering the full cycle: Code, Audit, Report, and Educate. It equips your team with the tools needed to maximize coding efficiency and provider revenue cycle success, all on a secure AWS cloud infrastructure. The platform has three core components: Coding Technology (a single-source system for code assignment, quality review, and document deficiency workflow collaboration), Auditing Technology (a post-bill compliance auditing platform with random coding sampling and configurable rule logic to define audit scope), and the C.A.R.E. Suite (effortless access to coding assignments, coder queue management, and real-time reports across your entire coding process). Every Edelberg coding engagement runs through C.A.R.E., giving you a live, auditable view of your account at all times.

Question 14

How do I get started with Edelberg & Associates?

Accepted Answer

The fastest way to get started is to book a free consultation at edelberg.com/contact or call us at 855-EA-CODES. In that first conversation, we learn about your current situation, including your specialty, volume, payer mix, and the challenges you are facing, and outline where we can add the most value. There is no pressure and no obligation. Most organizations find that even a single conversation surfaces opportunities they had not previously considered. We will follow up with a clear proposal so you know exactly what to expect.

Question 15

Can I request a live demo of the C.A.R.E. platform before committing?

Accepted Answer

Absolutely. We encourage prospective clients to see C.A.R.E. before making any decisions. A live demo gives you a real look at the dashboards your team would use, including production tracking, acuity reports, QA review queues, and real-time coding metrics. It also gives us a chance to understand your current reporting gaps and show you what visibility could look like for your organization specifically. To schedule your demo, book a consultation at edelberg.com/contact and let us know you would like a platform walkthrough.

Question 16

How quickly will someone follow up after I submit a consultation request?

Accepted Answer

Every consultation request submitted through our website or by phone is reviewed and responded to within one business day. Our intake process is actively monitored and every inquiry is handled personally by a member of our team, not routed through an automated queue. You will receive a direct response with proposed times to connect. For time-sensitive matters, you can reach us immediately at 855-EA-CODES (855-322-6337). We follow up consistently until a meeting is scheduled, because we understand that timing matters when revenue cycle and compliance issues are on the table.

Frequently Asked Questions

Coding Services

AI Medical Coding Validation

Denials & Legal

Compliance & Auditing

General

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