DRG Validation is conducted utilizing a pre or post bill chart review. The criteria utilized for chart selection is algorithm based and supports ICD-10 coding compliance. If recommendations are made for DRG change, communication will be addressed with coders and/or designated individuals at the hospital. A summary of findings will be submitted to the Executive team at the facility reporting the number of charts reviewed, the number of recommended changes, the actual number of changes and the revenue change. DRG education will be provided if indicated.

• Pre-Bill Review
• Algorithm-Based Compliance Assessment
• Unbilled Claim Assessment
• Reporting Dashboard

The revenue integrity function is utilized to ensure optimal financial performance for outpatient services. This is accomplished by performing and or updating the Charge Description Master (CDM). Revenue Integrity compliance and support will be provided utilizing national correct coding initiatives (NCCI), Medical unlikely edits (MUE) and charge capture. A dashboard of findings will be provided to the facility. Education will be provided if indicated.

• Charge Description Master
• Outpatient Claims Review
• Revenue Integrity Compliance
• Charge Master Updates
• Charge Capture

Clinical Documentation Improvement (CDI) is a process used in hospitals whereby nurses and/or specialists review clinical documents and provide feedback to physicians. The communication to physicians is utilized to aide in complete and accurate documentation. The documentation will address questions about coding, quality measures and overall care management of a patient. Process improvement initiatives are utilized to close the gap between coders and Clinical Documentation Specialist utilizing, ICD-10 International Statistical Classification of Diseases and Operations and Clinical Terms. Real-Time reviews and real-time query processes also becomes a part of the process improvement initiative.

• Process Improvement
• Communication Enhancement
• Query Process
• Real-Time Reviews

On request, Health Information Management Departmental analysis is provided to include Transcription Cost analysis and benefits, Coding Compliance and Staffing capacity and Productive analysis. After the initiation of an Electronic Health Record a process improvement project can be implemented to enhance work flow and eliminate duplicate processes.

• Departmental Analysis
• Evaluate Transcription Costs Benefits Analysis
• Coding
• Staffing Capacity and Productivity Analysis
• EHR Adoption Assessment