Physician-Led Clinical Validation for Hospitals

Capture the true clinical picture and ensure proper compensation for services rendered

 

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.

With acute care facilities 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.

HCS Consulting’s Physician-Led Clinical Validation solution for hospitals 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.




MAINTAIN COMPLIANCE


Mitigate fraud and abuse penalties through identification of incorrect coding and clean claims on the front end.



OPTIMIZE REIMBURSEMENTS


Increase reimbursements and decrease denials with physician queries and physician-led clinical documentation reviews.



DRIVE POPULATION HEALTH


Be in a better position to predict and target population health opportunities by improving the clinical accuracy on inpatient claims.


Approach

  • Our approach differs from traditional physician-directed reviews, clinical documentation improvement and coding as it is an end-to-end oversight control of the entire process
  • By leveraging physicians and technology, we can achieve sustainable results in quality, compliance, and reimbursement
  • Through clinically-focused analytics, data is captured to identify challenges by discipline and DRG categories for focused medical record clinical validation audits

Outcomes

Outcomes results for Physician-Led Clinical Validation audits for a 150-bed hospital with a clinical documentation improvement program and coding manager conducting quality validation reviews. Extrapolated revenue impact across 12 months would be $744,000 on a 200 record per month sample.


Service

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.

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HCS CONSULTING

A consulting company providing solutions for Revenue Integrity to a diverse range of healthcare organizations nationwide. The company’s portfolio delivers quality solutions to empower healthcare organization success, enhance clinical and financial outcomes, and enable the transition to value-based healthcare.

Location

2909 West Bay to Bay Blvd., Suite 500
Tampa, FL 33629
813-324-2107

Compliance Report Line:
813-369-5165
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