Who doesn’t want to achieve the highest compliance?
Our Physician-Led Auditing and Compliance Services provide Acute Care, Rehabilitation and Specialty Services Facilities/Clinics, Physician’s Practice and Clinician's Office with:
Inpatient and Outpatient Coding Compliance
Validation of DRGs, or APC reimbursement systems, and ICD-10-CM/PCS, CPT-4, HCPCS selections and assignments
Validation of the principal diagnosis, first-listed, and/or principal procedure selections and assignments
Validation of all secondary MCC, CC and other reportable diagnosis and/or procedure selections and assignments together with sequencing logic, regardless of impact to DRGs, or APC calculation, to ensure overall coding quality (Complete Code Review)
Validation of Present on Admission (POA) reporting
Validation of clinical and physician documentation improvement issues
Validation of query issues and compliance
Validation of date-of-service discrepancy issues
Validation of admission order, medical necessity and patient-type issues
Validation of discharge disposition and acute DRGs transfer discrepancy issues
Validation of operational assessment related to coding – incomplete source documentation (medical record) for accurate coding and workflow issues
Validation of all the above elements, which directly and potentially impact under-coded and over-coded issues in addition to level(s) of severity
Our Effective Services include:
Root Cause Analysis
Frequent Executive Record
Financial Impact Analysis based on findings
Education sessions for coding staff based on identified “teaching opportunities”, where requested, and schedule permits training on specific coding/abstracting/query logic on a case-by-case basis for options and assessments
