A structured coding and billing audit validation program will assist your facility in preventing development of patterns of noncompliance which can 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, CPT4 and HCPCS coding and billing validation audits performed by credentialed coding professionals experienced in coding, and reimbursement compliance. Our on-site or remote validation audit process assists your organization in identifying and correcting occurrences of "over " and "undercoding." Recommendations for coding changes are supported by authoritative, official coding and billing references. Potential documentation issues are identified. A comprehensive documentation of findings is submitted in detail and summary reporting format.
DRG Audit
This audit consists of inpatient records. ICD-9-CM diagnosis and procedures along with the corresponding DRGs are reviewed for coding compliance. Discharge status assignment, and present on admission indicators are also verified at the discretion/need of the client.
MS-DRG Audit
Formal audits are available to check optimization of MCCs and CCs. HCS offers group and one-on-one training in the MS-DRG system, including both hospital staff and physicians.
RAC Reviews and Appeals
HCS Auditors are experienced in the RAC review and appeal process, having worked with the California RAC since 2006. Support is offered in the form of case review, trending, and preparation of appeal letters.
OIG High Profile Cases
Target review of high profile cases is conducted by HCS Auditors. Support is in the form of case review, summarization of findings, feedback and education for hospital staff and physicians.
Partial APC Audit
This audit consists of outpatient surgery and/or emergency room records. 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 UB, (patient's bill), may also be reviewed.
Full APC Audit
This audit consists of outpatient surgery, clinic and/or emergency room records. 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 UB (patient's bill).
Intervention Radiology Audit
This audit consists of outpatient interventional radiology records. CPT and HCPC procedure codes are reviewed for coding compliance. Review of ICD-9-CM diagnosis may be included. The UB (patient's bill) may also be reviewed.
Itemized Charge Detail Audit
Experienced nurses review the itemized bill against documentation in the medical record to verify items charged. Summary of findings are presented by department in a spreadsheet format at the conclusion of the audit.
Professional Fee Coding Audit
This audit consists of physician office/clinic or hospital based physician notes. ICD-9-CM Diagnosis and CPT procedure codes for professional fee billing are reviewed for coding compliance.
Coding Support
To assist your facility in maintaining coding production standards and controlling the billhold during periods of vacation, leave of absence, jury duty and/or illness, HCS provides 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
Remote coding delivers backlog assistance without scheduling difficulties or travel expense.
Electronic or scanned medical records may be coded remotely
Upload scanned medical records into unique password-protected portal for remote coding/abstracting
Establish direct remote access to your facility's abstracting system for virtual on-site coding. Charts are finalized remotely without additional paper flow or on-site data entry
Professional Fee Coding
On-site or remote as above
Assembly and Analysis
On-site assembly of records and analysis of the record for deficiencies.
Data Entry
Back-up HIM clerical support
Coding Education & Training Tutorials
Because education and training are critically important components of any compliance program, HCS offers educational support both on-site and online:
Educational coding conferences at the conclusion of each validation audit
One-on-one tutorials for newly-hired coding staff
Educational tutorials on focused topics for Coders and other hospital 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 Joint Commission 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 Medical Records Director, Supervisor, or other Key Personnel, HCS can provide credentialed leadership staff experienced in the management of day-to-day operations to keep the department operating smoothly and control the DNFB in times of transition.
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.
