Caral Edelberg, CEO, Edelberg & Associates
A well-regarded medical coding expert, sought-after healthcare compliance educator, and a frequent speaker and author on healthcare management topics, Caral Edelberg—a thought-leader in the healthcare landscape for more than four decades—executes each of these variegated roles with finesse. And while fulfilling the responsibilities, there is one core factor that Edelberg regards as her stimulus to constantly propel forward: the commitment to make medical coding and compliance more efficient through innovation. Driven by such fervor, she founded Edelberg & Associates in 2008 to tap into the overlooked opportunities in the healthcare compliance realm. The focus of the company is to leverage their industry-leading domain knowledge and expertise in medical coding, compliance, and analytics, to deliver impactful and measurable gains for healthcare organizations. Effectively accomplishing this vision today, Edelberg & Associates secures a prestigious spot among global organizations as a pacesetter of modern healthcare compliance. Further enunciating on the objective of the company, Edelberg, the founder, chairperson and CEO of Edelberg & Associates, asserts, “Our standing has always been simple and clear: reduce risk and increase value.”
When it comes to tackling healthcare compliance challenges, there are three Rs that are integral to every physician group, hospital, and healthcare practice: Risk, Regulation, and Revenue. “We merge sophisticated analytics, process discipline, and educational initiatives into our medical coding and compliance programs to ensure that the challenges associated with the three Rs are redressed with ease,” says Edelberg. To make that possible, the company utilizes their leading-edge in-house medical coding platform CLEAR. The coding platform provides an integrated workflow and dynamic coder queue management for today’s demanding revenue cycle needs. “We have developed CLEAR coding using a combination of unrivaled expertise and years in the trenches with healthcare organizations,” says Edelberg. With the help of the platform’s state-of-the-art customizable 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 of the medical business process.
Together with that, the company offers an exhaustive suite of compliance services to mitigate risk, improve revenue, and assure financial viability for the health systems that they serve.
Discussing further, Missy Stimler, VP of compliance and regulatory issues at Edelberg & Associates, mentions another major facet of a competent healthcare compliance practice that tends to be ignored—transparency of medical records among physicians and hospitals. “Healthcare stakeholders need access to easy-to-use dashboards where they can view and update patient data on a real-time basis, thus simplifying the healthcare documentation process,” she states. CLEAR platform’s role-based dashboard views—providing access to all clinical and non-clinical partakers—are precisely designed keeping those industry requisites in mind. Along with that, Edelberg & Associates also devises various educational initiatives to guide doctors and nurses to record patient data more accurately—especially for high-acuity patients—and take a proactive stance in compliance documentation. On the other hand, through its extensive suite of compliance services, the company allows healthcare providers to enjoy greater visibility into the efficacy of the medical coding operations.
Besides offering high-performance compliance and coding solutions, Edelberg & Associates is also adept at providing in-depth auditing services spearheaded by Stimler. “The most distinguishing element of our auditing practice is that we do not standardize patient cases by putting them in one mold,” adds Stimler. Explaining this through an example, she says: “Consider an emergency room of a hospital encounters numerous high-acuity patients. There are two patients, one with chest pain and the other with a severe stomach ache. On the surface, both these cases might seem like regular emergency room visits. However, upon further investigation, it might come to light that the patient with chest pain has signs of genetically acquired heart disease.” Most of the auditors fail to understand these subtleties while doing medical coding. This is where Edelberg & Associates excels—the company trains payer auditors to pay attention to the finest details of a patient so that the documentation is precise.
Edelberg greatly attributes her team as the true strength behind the success of Edelberg & Associates. “Every employee/ medical coder in Edelberg & Associates has served in large medical practices for five years or more,” she says. This is one of the reasons why the company can closely relate to the industry pain points. Edelberg, however, feels her company is still at the tip of the iceberg and there are more opportunities in medical coding waiting to be discovered. Moving ahead, she intends to enhance the company’s solutions and roll out their in-house coding platform as a standalone offering for other healthcare compliance services companies. “We are poised to usher a new horizon for the medical coding domain,” concludes Edelberg.