LexiCode -- (800) 448-2633 -- Quality Health Information Coding Services

LexiCode Services

Compliance and Reimbursement Audits

PDF document:Health Information Auditing and Consulting

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:

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)
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.

Audit Services 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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