Rigorous Audits to Optimize Operations
Benefit from a truly collaborative and educational approach to identifying areas of improvement and devising an action plan based on the findings. Our experienced and credentialed auditors are driven to create meaningful impact by working closely with your team.
Your Growth is Our Goal
Enriched by decades of experience, we understand that each business has its own set of challenges, processes and goals. That’s why ours is not a one-size-fits-all approach. We are committed to your growth and take the time to understand your organization’s needs so we can tailor the right solutions. Our medical auditing solutions can be customized to optimize your business operations.Â
Coding Quality Review/Auditing Support - RemoteÂ
Expertise in Contracted Coding Quality Review/Auditing Solutions (Outsourcing) could be the answer to staffing shortages and improving the unbilled volume/dollars. We assist in facility and provider-based arenas in the smallest of offices, clinics, facilities to the larger academic, teaching and trauma centers. In addition to outsourcing solutions, we provide long-term or short-term support services.
Coding Compliance Audit and Data Quality Review
Ours is a collaborative and educational approach when it comes to auditing and quality reviews. We conduct a thorough review and discuss findings with you and your team to help create an impactful action plan. The final reports include cumulative and individual coder results.
We also monitor performance patterns by coders and the facility teams to help identify and address gaps in the process.
Diagnosis-Related Groups (DRG) and Ambulatory Payment Classifications (APC)Â
DRG and APC Audits verify the accuracy and consistency of the facility’s coding, charging, billing and information systems practices specific to Medicare’s Prospective Payment System (PPS) guidelines.Â
Documentation Review
We review documentation practices to ensure support of optimal code assignment and identify documentation opportunities to optimize reimbursement and mitigate risk. Along with the MS & APR DRG data, we highlight the following code status indicators: CC (Complication or Comorbidity), MCC (Major Complication or Comorbidity), ROM/SOI (Risk of Mortality/Severity of Illness), PSIs (Patient Safety Indicators), HACs (Hospital-Acquired Conditions).
Less than 50% of healthcare and physician groups meet their revenue goals. Learn how to effectively identify gaps.
How You Will Benefit
- Facility and provider-based support
- Full outsource or staff augmentation
- AHIMA, AAPC, ACDIS credentialed team
- Decades of industry experience
- Collaborative relationship
- Ability to adapt to changing facility requirements
- Comprehensive quality program
- Consultative observations
- Education options
Some of Our Result-Oriented Actions
- All pending volumes of data can be processed within a record turnaround time of 24 hours
- Achieve over 98% accuracy in processing and documenting medical records
- Compliant and accurate medical coding
- Enabling your team to prepare and focus on quality audits
Trusted by
Critical Access & Rural Health
Provider Offices
Clinics
Small to Large Healthcare Systems
FAQs
We are committed to delivering high impact with domestic and global solutions that will allow you to maintain efficient business operations while you focus on patient care. This extends across all our solutions from auditing and medical billing to education and electronic data management. Learn more here.
We understand the importance of confidentiality and privacy in healthcare data management. As a HIPAA compliant organization, we take this responsibility very seriously by using secure internet connectivity for our operations. Our teams are also well-trained and up to date with the latest regulations so you can rest assured that your data is safe with us.
Our team of experienced professionals will work closely with your team to understand your requirements, your challenges and your processes. This collaborative approach helps us devise solutions customized to your needs. We also conduct regular performance reviews to assess the impact of our solutions.
A dedicated team of professionals is available to offer regular support and customer service should you have any questions or concerns. Fill out the Customer Support form on our contact page to get help.
Our team of skilled and experienced professionals helps address staff shortages by easing your team’s workload. We effectively identify gaps and recommend corrective measures to streamline operations. By collaborating with your team and using an educational approach, we empower your staff by increasing efficiency.
Our coding quality review and auditing support can help you effectively improve unbilled volumes by identifying coding errors, improving documentation practices, managing denials and by regularly assessing the process.
Comprehensive monitoring and analysis allows us to identify and address process and quality gaps. We combine our expertise with advanced tools to closely track coding activities and assess quality. Through meticulous analysis, we are able to successfully identify areas of improvement and recommend corrective actions.
DRG and APC audits play the all-important role of assessing whether a healthcare organization’s coding, charging, billing and information systems are accurate and consistent with the guidelines set by Medicare’s Prospective Payment System (PPS). These audits help identify any discrepancies or errors in coding that could lead to inaccurate reimbursement or compliance issues.
We thoroughly review documentation practices to ensure they support the most accurate code assignment. We also identify opportunities for optimizing your reimbursement process and reducing risk. By analyzing the MS & APR DRG data, we pay special attention to specific code status indicators —CC, MCC, ROM/SOI, PSIs, HACs and HCCs—which help us assess the complexity and severity of the conditions being coded. This comprehensive review process informs how and where documentation can be improved to better align with coding requirements.
In addition to MS & APR DRG data, we also use code status indicators such as CC, MCC, ROM/SOI, PSIs, HACs and HCCs.
CC and MCC assess complexity and affect code assignment and reimbursement while ROM/SOI determines severity and influences DRG assignment and reimbursement. PSIs highlight potential patient safety issues, triggering further investigation whereas HACs indicate conditions developed during hospitalization, impacting coding accuracy and reimbursement.
Let us Help You Create More Impact
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