Our experienced healthcare staffs provide Medical Chart Auditing, Certified Coding, Denials & Appeals Management, CDM Review, Medical Necessity, Inpatient & Outpatient Hospital Review services for healthcare organizations.
Hospitals and healthcare providers lose millions of dollars every year due to mismanagement of the billing process. This ranges from inaccurate charging, such as undercharging for a service or procedure or missing a charge altogether. Accurate charge capture processes will improve cash flow and increase revenue which adds up to a healthier bottom line satisfying regulatory compliance.
Accurate and complete chart auditing is fundamentally important to maximizing reimbursements in today’s physician practices and for avoiding external audits by Medicare and other payers. Our audit services designed to assistance your physician practice and or clinic in achieving your audit requirements. Our services provide commitment to building lasting client relationships and our desire to help you achieve your needs.
All applicable codes must be accurately submitted to reflect the acuity of the patient a provider is treating. RAF reporting is vital to a healthy revenue cycle, and more important, to a healthy patient.
Many hospitals and physicians have seen their denials notification increase significantly over the past year which has direct impact on earnings since the service has already been provided and the cost has been incurred.
Understanding and correcting the causes of claim denials can drastically reduce lost revenue. Our experienced denial management team of Certified Case Managers, RN’s and Certified Coders with denial defense experience can assist in defending and managing your denials and appeal process.
Every HIM department should have policies and procedures in place requiring periodic external coding reviews by an Independent Review Organization. Whether your review is random or focused, retrospective or prospective, our certified and experienced team of professional inpatient and outpatient coding professionals are prepared to meet your expectations on a permanent or on interim basis.
Often, the status of patients at the time of admission or discharge significantly influences the amount and method of reimbursement hospitals receive. Therefore, hospitals have a duty to ensure that admission and discharge policies are updated and reflect current CMS rules.
In order for admissions to be considered medically necessary under the Medicare program, the patient must have a condition requiring treatment that can be provided only in an inpatient setting. If the patient safely can receive treatment in a less intensive setting, such as outpatient observation, the patient should not be admitted.