If your healthcare practice struggles with incomplete medical records, denied bills, constant coding updates, backlogs of medical record coding and staff exhaustion, CBIZ can help. Our health information management services staff will work with your medical records department to create efficient and accurate coding processes that will result in proper billing and enhanced revenues. With an expertise in MS-DRGs, CBIZ will focus not only on immediate coding needs, but also on sustaining long-term organizational coding accuracy.
Common engagements include:
We draw from proprietary analytics and more than 30 years of coding expertise to conduct in-depth review of your ICD-10 coding and determine where processes could be improved or streamlined. Our I-10 Check solution differs from other coding evaluations in a number of ways.
Outpatient Record Review
Our outpatient record review program is intended to guide the continuous improvement of physician documentation, coding, and billing processes; improve data integrity; and ultimately capture the correct and earned reimbursements, which are necessary for the continued growth and viability of your organization. The review will assess the appropriateness of documentation and determine the accuracy of the CPT coding, addressing proper code selection and appropriate level of specificity. We will identify any inconsistencies between ICD and CPT coding and inclusive CPT codes that have been unbundled, which result in the maximization and overestimation of revenue.
Inpatient Record Review
CBIZ will conduct a review of records to determine the accuracy of the coding performed and the diagnosis-related groups (DRG) assigned. The objective of this program is to ensure that a hospital accurately codes its inpatient claims based on appropriate documentation and receives correct Medicare and Medicaid reimbursement in compliance with federal and state regulations. The program is intended to guide the continuous improvement of physician documentation, coding, and billing processes; improve data integrity; and ultimately capture the correct and earned reimbursements, which are necessary for the continued growth and viability of the organization.
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Contract Coding & Scanning
CBIZ will provide a facility with an experienced consultant to eliminate the backlog coding of inpatient and outpatient records, grouping, and data entry (abstracting) on a temporary basis. Coding will be provided in compliance with established hospital guidelines and Centers for Medicare and Medicaid Services (CMS) and Uniform Hospital Discharge Data Set (UHDDS) rules and definitions.
CBIZ is employing new technology to further meet our clients’ long-term and short-term coding goals. If backlogs due to vacation, sick-time and unplanned staffing events have adversely impacted a department, we can provide Contract Coding Scanning (CCS), to eliminate the month end crunch and decrease unbilled accounts.
Under this new service, all of a facility’s records—inpatient, outpatient, emergency department, clinic visits, and more—can be scanned on-site and uploaded to our website repository. Our coders will then review the record and assign codes on an electronic coding summary sheet. The turnaround time for code submission is within 48 hours.
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Data Quality and Coding Validation Review (DQCVR)
CBIZ will provide on-site, focused medical record reviews, general education for the medical staff on documentation requirements, education by service on issues affecting compliance with government regulations, and focused training for coders based on audit results. Our DQCVR Program extends over a period of twelve months to ensure maximum effectiveness and to adequately cover the training needs of the staff. This program is best conducted in “small doses” because there is significant behavior modification required and an abundance of information to absorb. This method will help achieve long-range goals and the best long-term benefits.
Our physician workshop will be presented to the medical staff and all other interested personnel. This session will include documentation issues focusing on the importance of consistent physician documentation in order to assure the accuracy of the code assignment and result in appropriate reimbursement. The discussion will address Office of the Inspector General issues, coding errors from the audits, and medical necessity guidelines.
A question and answer period will be encouraged. This will allow interactive time for the participants to raise specific questions and issues. Questions that can’t be resolved on-site will receive a written response.
Hospital coders will be provided with training seminars, including case studies and examples, to guarantee coding accuracy and the correct assignment of codes reflecting the greatest level of specificity. The hands-on session will cover quality issues, use of appropriate CMS and UHDDS rules and definitions and topics based on feedback from the physician education and documentation concerns.
In addition to in-service sessions, CBIZ will conduct an annual general coding workshop when the new codes are released. This workshop will include an overview of the reimbursement system, the latest OIG initiatives, and any “hot” issues. These workshops will be offered for both ICD and CPT coders.
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The objective of our interim management program is to supply health information management departments with the assistance of an experienced consultant, whose skills match the needs of the facility. Two common roles of the CBIZ consultant interim manager have included the supervision of Joint Comission on Accreditation of Healthcare Organizations (JCAHO) survey preparations and the prevention of the disruption of department workflow in the absence of a permanent manager.
The interim manager will attend and represent the health information management department at any hospital functions or meetings as required. The consultant will prepare a final report listing accomplishments, changes or recommendations made and any observations needing discussion or resolution. If requested, our staff will stay on after the management position is filled to assist in the transition process.
Physician Data Practice Assessment (PDPA)
The objective of the CBIZ physician data practice assessment program is to evaluate the completeness and integrity of the documentation, coding, and billing processes in the medical practice. We will evaluate the billing procedures from the initial patient encounter to the filing of the claim and the posting of the payment or write-off. A review of patient medical records against billing data will be conducted in order to determine the appropriate CPT, HCPCS and ICD coding, extent of charge capture for services and supplies, compliance with regulations, and potential for additional encounter optimization. This assessment ensures that a practice captures the appropriate reimbursement for all services provided and complies with reimbursement regulations and guidelines, and encourages continued improvement through follow-up evaluations.
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