Revenue Integrity and Payment
CODING QUALITY AUDITS
Ensuring accurate clinical documentation, medical coding, and billing are crucial to the financial health of your organization. We understand the operational challenges you face to successfully reach your revenue goals and maintain compliance. Our clients seek our expertise for targeted reviews of specific concerns, to start an internal compliance auditing program, or ongoing internal audit support.
We will work with your team to identify the goal, provide a comprehensive review, and one on one education for your coding, management and clinical staff.
We offer facility inpatient, outpatient and professional service coding expertise, as well as multi-specialty auditing experience. Our consultants are either AHIMA or AAPC credentialed and have years of operational experiences that drive our passion for developing a strong working relationship with your team and provide you the confidence and peace of mind in your choice to work with us.
Our consultants have specialized training through the AHIMA Train the Trainer program. Our consultants have years of experience working in facilities and educating physicians. This enables us to effectively customize training to meet the needs of the individual client including everything from one-on-one physician education related to clinical documentation improvement and up to general education for larger groups. We can also provide assessments of the coding and documentation and work closely with our Revenue Cycle Department to support you in ensuring clean claims.
Regulatory Support for Legal Matters
The Revenue Integrity and Payment Department serves our legal clients in a variety of ways, partnering with them to mitigate the heavily regulated healthcare industry. We have developed strong relationships and are accustomed to working with our clients to serve as an independent review organization (IRO) for Corporate Integrity Agreements. We provide value to investment firms, clients acquiring practices, or a practice being acquired by meeting their due diligence needs related to coding and billing reviews, with a strong emphasis on compliance and financial impact. We also provide coding and billing reviews under attorney-client privilege and internal and defensive audit support to develop a sound and supported rebuttal.
CHARGEMASTER AND CHARGE CAPTURE REVIEWS
We offer remote line-by-line chargemaster reviews, making recommendations for code deletions, additions, CPT/HCPCS/revenue code matching for reimbursement analysis, to name a few. Our review will ensure that the facilities CDM accurately reflects all services provided. Our review includes policy and procedures, maintenance processes and mark-up policy reviews. Our team works directly with internal operations personnel to discuss charges by department. Our comprehensive review delivers a clean chargemaster for uploading and an in-depth reporting of your charging opportunities. Additionally, we perform charge capture reviews of a sample of Medicare claims and corresponding clinical documentation and bills for charge capture accuracy. The review assesses the complete revenue cycle charging and coding process and ensures that the facility is billing with accurate coding and documentation.
- Education, Training, and Speaking Engagements
- Interim HIM Management
- Epic EMR support, led by an Epic-certified Consultant (Coding and Abstracting, Deficiency, Release of Information, Identity Modules)