A structured coding and billing audit validation program will assist your facility in preventing development of patterns of noncompliance which potentially result in OIG fraud and abuse investigations and/or loss of significant revenue.
As an external non-biased third party, HCS provides DRG, APC, ICD-9-CM and HCPCS coding and billing validation audits performed by credentialed coding and billing professionals experienced in coding, billing and reimbursement compliance. Our on-site validation audit process assists your organization in identifying and correcting occurrences of "overcoding/billing" and "undercoding/billing." Recommendations for coding/billing changes are supported by authoritative, official coding and billing references. Potential documentation issues are identified. Comprehensive documentation of findings are submitted in detail and summary reports.
DRG Audit
This audit consists of inpatient records. ICD-9-CM diagnosis and procedures along with the corresponding DRGs are reviewed for coding compliance.
Partial APC Audit
This audit consists of outpatient surgery and/or emergency room visits. ICD-9-CM diagnosis and procedures, CPT and HCPC procedure codes, along with the corresponding APCs are reviewed for coding compliance. This audit does not include review of procedures assigned by the charge master. The UB92, (patient's bill), may also be reviewed.
Full APC Audit
This audit consists of outpatient surgery and/or emergency room visits. ICD-9-CM diagnosis and procedures, CPT and HCPC procedure codes, along with corresponding APCs are reviewed for coding compliance. This audit includes review of all procedures assigned on the UB92 (patient's bill).
Clinic Audit
This audit consists of outpatient clinic visit records. The ICD9-CM diagnosis and CPT E&M codes are reviewed for coding compliance.
Intervention Radiology Audit
This audit consists of outpatient radiology records. CPT procedure codes are reviewed for coding compliance. Review of ICD-9-CM diagnosis may be included.
Physician Coding Audit
This audit consists of physician office records. ICD-9-CM Diagnosis and CPT procedure codes are reviewed for coding compliance.
Coding Support
To assist your facility in maintaining coding production standards during periods of personnel vacations, leaves of absence, jury duty and/or illness, HCS is prepared to provide coding assistance by credentialed and experienced coding professionals.
On-Site Coding
HCS will deploy seasoned credentialed coding professionals to your facility to assist in backlog coding.
Remote Coding
With the overwhelming shortage of experienced proficient coders, consider one of several HCS "OFF-SITE CODING" alternatives:
Scanning of medical records by a qualified technician onto a secure HIPAA compliant server for remote coding/abstracting.
Allowing HCS to dial directly into an electronic medical record and HIM abstracting system to code and abstract directly from a distant location.
Extraordinary measures are taken to preserve and safeguard confidentiality of patient health information.
Data Entry
Inputting of coded / abstracted data into the facility's information system.
Physician Office Coding
On-site or remote as above.
Assembly and Analysis
On-site assembly of records and analysis of the record for deficiencies. Coding Education & Training Tutorials
Because education and training are critically important components of any compliance program, HCS offers:
Educational coding conferences at the conclusion of each validation audit;
One-on-one tutorials for newly-hired coding staff;
Review tutorials on focused topics for seasoned coders and billers;
"Train the trainer" educational program
Annual seminars addressing upcoming changes to ICD-9-CM, CPT, DRG, and APC coding systems.
Online Coding Tutorials offer CEUs and provide a convenient and economical alternative to the classroom setting
HIM OPERATIONAL ASSESSMENT
During periods of management transition, a review of operations and workflow within the health information management department can serve as an invaluable tool for restructuring and maximizing resources. A detailed assessment of the following areas will be presented in a written summary:
Flow of data and information from point of registration to permanent shelf filing;
Compliance with critical JCAHO and Title 22 standards;
Staffing skills;
Productivity quality and quantity standards;
Operational budget; and
Customer service quality
Opportunities with recommendations for improvement
HIM DEPARTMENT INTERIM MANAGEMENT
When in need of an HIM department manager or director, HCS can provide credentialed leadership staff experienced in the management of day-to-day operations.
JCAHO SURVEY INFORMATION MANAGEMENT PREPAREDNESS
To assist your acute care facility for its upcoming JCAHO/CALS survey, HCS consultants will assess and prepare your HIM department for the survey process.
OSHPD DATA CORRECTIONS
HCS offers onsite help in your online editing of OSHPD data. We have experts who are well seasoned in the reporting requirements for inpatient, outpatient surgery, and emergency room cases. Let HCS submit your files to OSHPD and correct the data submissions, while training your staff OSHPD logic.
PHYSICIAN QUERY FORMS
MS-DRGS AND RAC reviews require more specific information, and documentation from physicians. Take advantage of HCS's prepared set of online Query Forms, or have HCS customize queries for your facility.
