Compliance and Reimbursement Audits

Value of Compliance and Reimbursement Audits:

  • Identifies revenue opportunities (underpayments)
  • Ensure compliance (overpayments, non-compliance with coding guidelines)
  • Identifies root causes of coding issues: coder error, physician documentation, workflow
  • Coder feedback is reviewed and discussed prior to finalization
  • Flexible scheduling without a resource commitment
  • Detailed trend reporting, coder/provider education, solid recommendations
  • Internal quality assurance ensures second level review of recommendations
  • Work collaboratively with your team to ensure the process is efficient and organized

Types of audits:

  • Comprehensive Inpatient Coding Audits
  • Outpatient Coding Audits
  • Professional Fee/Physician-Based Audits – Evaluation & Management, Surgical Encounters
  • Specialty Audits
  • Long Term Acute Care (LTAC)
  • Behavioral Health/IPF-PPS
  • Rehabilitation Audits/UB-04 post discharge/IRF-PAI coding:
  • Skilled Nursing Facilities
  • HCC (Hierarchical Condition Category)/RADV Coding Audits

Other Consulting Services

  • Interim HIM/Coding Management
  • Health Information Management Operational Reviews
  • Coder Education
  • Provider Education
  • Interim CDI Specialists
  • Customized projects