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Sonal Patel

Health Care Coder and Compliance Consultant

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Overview

Sonal Patel serves as the remote coding and compliance consultant for Nexsen Pruet. She is committed to providing clients coding, compliance, and documentation guidance based on government and private payer regulations. She provides detailed, high-level findings reports for practices under post-payment audit reviews. She creates custom corrective action plans for both Part A and Part B providers. Sonal assists attorneys in their many defense strategies of diminishing scrutiny and leveraging for positive outcomes based on her understandings of value-based and fee-for-service programs. Sonal is the client’s biggest advocate.

Sonal comes to Nexsen Pruet with her focused concentrations on the myriad of reimbursement complexities faced by both private practice physicians, as well as hospital systems. It was during her 10 years in Houston, Texas that Sonal began her journey guiding specialty physicians and surgeons in correct coding and billing practices at Texas Medical Center’s premiere billing company. She later propelled her career and gained footing at the leading cancer institution in Houston. Here, she performed thousands of retrospective audits on professional charges to ensure accuracy of coding and clinical documentation to maintain and gain reimbursement levels.

Education

Kaplan University, Certificate Medical Coding III
The Ohio State University, M.A., South Asian Art History
Hiram College, B.A., Art History, with Honors

Civic & Professional Memberships
  • CPMA, Certified Professional Medical Auditor
  • CPC, Certified Professional Coder
  • CMC, Certified Medical Coder
  • ICD-10-CM Proficient, International Classification of Diseases, 10th Revision, Clinical Modification
  • AAPC (American Academy of Professional Coders)
  • PMI (Practice Management Institute)
  • AMBA (American Medical Billing Association)
  • NCMGMA (North Carolina Medical Group Management Association)
Overview

Presentations 

Presenter, “Compliant Coding & Billing For TeleHealth During COVID-19,” 1st Healthcare Compliance, April 2020

Presenter, “Medi-Weightloss: The Road Map to Compliance,” Nexsen Pruet, August 2018

Professional Interviews

Guest Speaker, “Pro-Tips for Surviving TPE Audits,” Alpha Coding Podcast with Toni Elhoms, March 2020

Quoted In, “Coding for Revenue,” by Lisa A. Eramo in Medical Economics, August 2019

Quoted In, “Boost Revenue by Getting Coding Right,” by Lisa A. Eramo in Medical Economics, July 2019

Quoted In, “Level of Care Coding Tips to Boost Revenue, Mitigate Risk,” by Lisa A. Eramo in Medical Economics, May 2019

Quoted In, “Avoid Denials When Selecting Level 4 E/M Office Visit Codes Based on Time,” by Lisa A. Eramo in Medical Economics, October 2018

Quoted In, “Strategies for Appealing Ob-Gyn Claims,” by Nancy Lopez in Billing Paradise Blog, September 2018

Publications

Author, “Q & A: Compliant Coding and Billing for TeleHealth During COVID-19,” 1st Healthcare Compliance, April 2020

Author, “2020: Abuse, Misuse, and Misunderstandings of Modifiers -25, -59, and -62,” HCCA’s Compliance Today, slated for August 2020

Author, “Improve Provider Documentation through TPE Audits,” AAPC’s Healthcare Business Monthly,  February 2020

Author, “Inspect Coverage for HBO Therapy for Radiation Proctitis,” AAPC’s Healthcare Business Monthly, August 2019

Author, New Anti-Kickback Provisions Affect Labs and Physicians,” AAPC’s Healthcare Business Monthly, September 2018

Author, “Don’t Confuse Toxicology Screenings with Confirmations,” AAPC’s Healthcare Business Monthly, November 2018

Author, “July 2018 Need-to-Know Updates from the OIG Work Plan,” AAPC’s Healthcare Business Monthly, September 2018

Author, “August 2018 Need-to-Know Updates from the OIG Work Plan,” AAPC’s The Knowledge Center, September 2018

Sonal is a true Buckeye and Mid-Westerner having grown up in Cleveland, Ohio since the age of 3. She is currently residing in the greater Chicagoland area.

Prior to her healthcare career, Sonal mastered her love of research and writing. She studied and worked extensively in the field of art history, with a focused concentration on modern and contemporary South Asian art. She loved her work at The Smithsonian Institution in Washington, District of Columbia, as well as her time at the Peabody Essex Museum in Boston where she extensively analyzed the important works held onto by a collector before his passing. Her passion for art continues to this day. She is never far from an art museum or gallery opening.