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LexiCode's
Compliance & Reimbursement Audits
The
first step to accurate clinical data is to identify where opportunities
exist. Is your coding compliant with official guidelines? Are there hidden
documentation or coding problems causing noncompliance or revenue inaccuracies?
LexiCode
offers a variety of audits to help your facility meet its compliance and
reimbursement objectives. Our audits can include a review of all record
types in both the hospital based and physician based settings from acute
med/surg facilities and physician practices to non-acute care settings
including rehabilitation, behavioral health, long-term care and skilled
nursing facilities.
Audit
types include:
| MS-DRG
|
Audits
targeting compliance, reimbursement, severity adjustments and OIG
fraud & abuse initiatives through retrospective, concurrent
or ongoing monitoring |
| APR-DRG
|
Audits
targeting validation of APR-DRG, Severity of Illness (SOI) and Risk
of Mortality (ROM) |
| AP-DRG |
Ensure compliant
and optimal performance for state and other third party reimbursement
and data collection |
| Evaluation
& Management |
Facility based
and physician based |
| APC
|
Review
of CPT codes as they relate to APC assignment |
| Comprehensive
|
Full
review of all code components for data collection, education and
comprehensive code level compliance |
| Rehabilitation
|
IRF-PAI
assessment of for Rehab Impairment Group/Code/Category, Etiologic
Diagnosis, Comorbid Codes with Tiers, Complication Codes, and Validation
of UB-92 Post Discharge Coding. |
| Physician
Documentation |
Identification
of physician documentation opportunities relative to complete code
assignment |
| Other
Audit Services |
Audits
for behavioral health, long term care, skilled nursing and other
non-acute care settings. |
Auditing
Deliverables:
LexiCode’s
auditing reports identify where, why and how any compliance or reimbursement
issues exist and how they can be prevented in the future.
Audits
include:
- Detailed Trend Reports (e.g. DRG, physician,
coder)
- Comparisons to previous reviews (when applicable)
- Unique classification system which identifies
physician documentation, coder and/or workflow issues
- Explanations for each coding recommendation citing
official references
- Customized reports available upon request
- Exit Conference with Management
- Coder Education with AHIMA Continuing Education
credit
- Onsite or Video Conference Presentation of Final
Report
Auditing
Methodology:
Through
an extensive review of your health information records, our coding compliance
and reimbursement audits help you pinpoint areas for improvement, establish
performance objectives and develop an action plan to meet compliance and
accuracy goals.
Our
compliance team works with you every step of the way to ensure that the
audit accurately reflects your compliance, accuracy and reimbursement
goals. All it takes is one call to find out how we can complement your
compliance initiatives.
Please
contact us for additional information about
our auditing services.
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