Take coding to the next level with physician-led reviews
With health systems faced with increasing complexities to ensure appropriate reimbursement for services provided—financial risk has never been greater. Challenges are numerous and include new reimbursement models tied to quality, increased payer denials, and millions of dollars in unreimbursed care.
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.
Harmony Consulting Solutions Physician-Led Clinical Validation solution takes coding audit and validation reviews to the next level through a physician-directed clinical documentation review which validates whether the patient truly possesses the conditions that were documented in the medical record. This clinical validation happens remotely, in real time, and can significantly impact quality and bottom-line results.
- Increase clinical accuracy and reimbursements with physician queries
- With physician support in responding to CMS and payer denials, clients win more appeals
- By eliminating the rework of denials through clean claims on the front end, productivity can be increased
- Decrease fraud and abuse penalties by identification of incorrect coding
- By improving the clinical accuracy on inpatient claims, health systems are better able to predict and target population health opportunities. By focusing on comprehensive risk adjustment, we ensure data integrity that’s necessary to effectively drive population health management
- Physicians are trained in the principles of inpatient coding and focused on improving the specificity and accuracy of documentation
- Physicians review charts after the coder has assigned the DRG and before the bill is dropped
- Physicians uncover hidden truths in patient documentation and partner with coders to assign the most accurate DRG on all DRG reimbursed inpatient cases
- Physicians connect the clinical indicators in the chart and write peer-to-peer queries to identify the appropriate medical diagnoses