Take coding to the next level with physician-led reviews
Health systems are faced with increasing complexities to ensure appropriate reimbursement for services provided. Challenges include new reimbursement models tied to quality, increased payer denials, and millions of dollars in unreimbursed care.
Our solution takes coding audit and validation reviews to the next level through a physician-directed clinical documentation review. This clinical validation happens remotely, in real time, and can significantly impact quality and bottom-line results.
- increase clinical accuracy and reimbursements with physician queries
- secure support in responding to CMS and payer denials, clients win more appeals
- decrease fraud and abuse penalties by identification of incorrect coding
- predict and target population health opportunities
- ensure data integrity necessary to effectively drive population health management
- collaborate with physicians who are trained in the principles of inpatient coding and focused on improving the specificity and accuracy of documentation
- secure physician review of charts after the coder has assigned the DRG and before the bill is dropped
- uncover truths in patient documentation and partnering with coders to assign the most accurate DRG on all DRG reimbursed inpatient cases
- connect clinical indicators in the chart for peer-to-peer queries to identify the appropriate medical diagnoses
Expert guidance and leadership to drive lower denial rates
From implementation to evaluation to design, our team of highly qualified experts is equipped to put the best structure for your organization in place while building a culture of accountability and program oversight to drive lower denial rates.
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collaborate with experts on selecting your organization’s team, refining its processes, implementing its mid-stream corrections, and building and maintaining awareness among stakeholders
- rely on our talented team to assemble a command of the data
- enhance outcomes with the most appropriate tools for your organization
- identify root causes for your organization’s appeals, recovery, and prevention
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build a custom program that suits your organization as well as a culture of accountability and program oversight to drive lower denial rates
- Director
- Team Manager
- Team Lead
- Clinical Validation Reviewer
- Coding Appeals & Denials Specialist
- Medical Necessity Specialist
- Revenue Integrity Specialist
- Team Data Analyst
