Audit and validation reviews, achieving a higher level of billing integrity
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. Harmony Healthcare’s Revenue Integrity, Coding Audit and Validation Review services ensure reimbursement accuracy, evaluate compliance adherence, and achieve quality assurance.
Our solution includes expertise in the following areas:
- 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
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.
Harmony Audit 360 Process
Our clinical and technical 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.
The four points:
- 1. Conduct Preliminary Interviews – Establish audit objectives and priorities to ensure client expectations are met
- 2. Perform Audit – Deliver case details, overall findings and trends, and recommendations for education and remediation
- 3. Present Findings and Rollout Education – Discuss in detail the information gathered, Q&A session with coding team to provide information for sharing, and formulate and deliver final education plan
- 4. Follow Up – Within 2-3 months of initial audit, review a smaller sample size of charts to validate that education provided resulted in improved outcomes and that facility is receiving the guaranteed return on investment
Expertise with all Prospective Payment Systems
We perform coding quality and payment validation audits for all prospective payment systems including:
- MS-DRG Validation
- APR-DRG Validation
- APC Validation
- HCC Validation
- CMG Validation
- MS-LTC-DRG Validation
- Coding Quality Audits
- E&M Audit