Minimize errors to maximize revenue
The current climate of government scrutiny in healthcare dictates the need for adherence to accurate coding and billing processes including relevant documentation of medical billing codes, and proper charging of insurers for medical services rendered. Patient care, data integrity, compliance, and reimbursement are at risk when the severity of the illness, treatment provided, and mortality rates aren’t documented and coded accurately.
Our Audit and Validation staffing services ensure reimbursement accuracy, evaluate compliance adherence, and achieve quality assurance. Our auditing experts do more than uncover risks and opportunities for improvement; they work with your key stakeholders to achieve and maintain a higher level of billing integrity.
Harmony has developed an audit and education plan that incorporates a four-point approach for improving coding outcomes. 1) Conduct preliminary interviews 2) perform audit 3) present findings and rollout education, and 4) follow up.
Powered by our Validation Audit Technology (VALID)—a comprehensive cloud-based software—reviews are easily launched, and in-depth analytical reports are delivered providing complete transparency and accountability.
- Identify vulnerabilities through data analysis, chart reviews and CDI process assessment, with interwoven education on opportunity areas
- Customizable audit reports to provide leadership KPIs, comparative analysis and trending
- Narrative and graphical representation of audit outcomes
- Real-time monitoring of audit progress and results
- Standardized approach including categorization of coding outcomes for coder feedback
- Clinical Documentation – We evaluate the quality of physician clinical documentation for completeness, specificity, accuracy, and compliance
- Coding Quality – We determine coding accuracy and appropriateness of code selection
- Financial Impact – We identify missed revenue opportunities
- Regulatory Compliance – We evaluate overpayment risk and other regulatory compliance risks
- Telehealth Compliance – We review practitioner’s documentation and coding requirements for Medicare telehealth services reimbursement
- Medical Necessity – We evaluate whether the service’s a patient is provided are medically necessary
- Risk of Mortality and Severity of Illness – We evaluate the patient’s overall severity of illness subclass and risk of mortality subclass accuracy