Revenue Integrity, Coding, Audit, Reviews and Validation

Maximize quality, minimize errors.

Harmony Healthcare Offers Interim, Direct To Hire, Enterprise and International Solutions.

Revenue Integrity, Coding, Audit, Reviews and Validation

Harmony Healthcare offers a comprehensive suite of coding, documentation and compliance audit and validation services. Our areas of expertise include inpatient, outpatient, physician practices, specialty coding, and more. We provide expertise with all Prospective Payment Systems including MS-DRGs, APR-DRGs, CMGs, HCCs, APCs, and others.

Clients call on us to conduct coding, documentation and compliance audits for several reasons:

  • 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 evaluate practitioner’s documentation and coding requirements for Medicare telehealth services reimbursement.
  • Medical Necessity – We evaluate whether the services 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.

Compliance Auditing

One of the first steps to complying with the governmental recommendations is accurate data and reported results from an unbiased expert. Administrators can then use the data to ensure compliance with regulatory agencies and identify where opportunities for improvement exist. Medical record audits are the centerpiece of any organization’s compliance and revenue integrity program. Harmony has performed medical record audits across the spectrum of healthcare organizations including governmental, payors, and providers. We provide both onsite and remote audits, depending on your needs.

Our Harmony clinical and technical auditing experts do more than uncover opportunities, risks and areas for improvement; they work with your key stakeholders to achieve and maintain a higher level of billing integrity.

We provide quality auditing services for the following:

  • Coding Compliance Audits
  • Documentation Integrity Audits
  • Pre-RAC Risk Assessment Reviews
  • HCC Payor Claims Denial Assessments
  • Medical Necessity Reviews
  • Appeal Writing and Denial
  • Pre-Bill Reviews
  • Coder Education and Training

Providing expertise with all Prospective Payment Systems:

Harmony’s diverse auditing capabilities have provided coding, documentation and revenue integrity audit services to some of the largest health systems, major academic medical centers, regional medical centers and CAH’s across the country.

We perform coding quality and payment validation audits for all the 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
  • And more

Are you looking for an audit or a solution with measurable results?

Harmony Audit360:

Harmony recognizes that many times clients are looking for audit assistance, but are looking for a broader solution for improving their coding outcomes. Harmony has developed an audit and education plan that incorporates Harmony’s four-point approach for improving coding outcomes. The value of an audit is only as good as the action plan implemented from the outcomes. Harmony’s approach to assessing the coding quality and improving outcomes performance includes the following:

1. Preliminary interviews

Before every audit, we conduct an interview with the appropriate contacts at the facility to discuss the exact objectives of the audit. We’ve found that many times the sponsor wants something different than the department director. Education is the priority for the departmental managers while improving revenue cycle, compliance and work flow may be the priority for others. The preliminary interview establishes set priorities for the auditor, and makes sure our clients receive the value they expect.

2. Perform the Audit

Once the objectives are confirmed, we perform the audit and provide the following information as a part of our standard audit:

  • Details from each case in spreadsheet format listing code, DRG/APC/HCC/etc., auditor, rationale for changed codes, accuracy ratings, and dollar differences.
  • Overall findings and trends of the audit, including 5-10 financial impact analysis points for each.
  • Recommendations for education and remediation based on audit goals.

3. Present Findings and Rollout Education

Following the audit, we present our findings to the appropriate managers and/or sponsors and discuss in detail the information that we have collected. If the client finds the information to be complete, we will then typically set up a Question and Answer session with the coding team, and provide an opportunity for information sharing. Following this session, we formulate and deliver our final education plan for the facility.

4. Follow-Up

Our typical follow-up is within two to three months of our initial audit. We will review a smaller sample size of charts to validate that the education provided resulted in improved outcomes, and that the facility is receiving the return on investment, which is guaranteed.

The current climate of government scrutiny in healthcare dictates the need for a structured coding auditing and compliance program. The information we can provide will prove invaluable to your organization and keep you prepared for the uncertain levels of external scrutiny imposed by regulators. We are here to partner with you to provide the right solution to meet these requirements to make you successful.

Call Harmony now to uncover opportunities that may be hidden in your department! 813.369.5159