Unlocking the Benefits of Physician-led Clinical Validation: An Expert Q&A

HCS Consulting provides end-to-end project management, and highly specialized revenue cycle management and population health consulting solutions for a diverse range of healthcare organizations, from small physician groups to multifacility health systems. To meet client’s changing needs HCS expanded its portfolio. Clients can now leverage physician-led clinical validation to minimize risk and drive revenue recovery—with proven return on investment.

Get actionable insights from experts at HCS and learn how implementing physician-led clinical validation can give your healthcare organization sustainable results in quality, compliance, and reimbursement.

Q. Why is it important to conduct coding audit and validation reviews that are physician-led?

A. “Traditional coding methods just aren’t enough in today’s ever-changing healthcare landscape. Typically, hospitals have relied on medical records coders to identify and obtain the right codes leading to the correct reimbursement. No matter how competent and diligent coders might be, today is a complex healthcare environment. The possibility of error during the traditional process is very real. At best there are missed revenue opportunities. At worst, the provider is exposed to financial risk and penalties.”
—Ken Folkman, Director, HCS Client Solutions

Q. In what ways can physician-led clinical validation add value to a health system?

A. “The physician uncovers hidden truths in patient documentation and partners with clinical documentation specialists and coders to assign the most accurate DRG on all DRG reimbursed inpatient cases. This approach successfully ensures the medical specificity needed in ICD-10 is captured. Documentation is strengthened based on the clinical presentation of the patient resulting in defendable clinical documentation practices. In responding to CMS and payer denials, clients proactively prevent denials, significantly impact quality outcomes, and optimize bottom-line results. Recent case studies reveal a return on investment many times the cost associated with the audit.”
—John Pitsikoulis, Director, HCS & Analytics

Q. How do you ensure that the physicians are able to support your clients’ needs efficiently and effectively?

A. “HCS’s physician consultants use an innovative cloud-based platform that micro segments cases needing specialized review to identify challenges by discipline, physician, and DRG categories. This clinical validation happens remotely, in real time, and seamlessly with your current workflow.”
—John Pitsikoulis

Q. How are your clients benefiting from physician-led clinical validation?

A. “The physician reviews the chart after the coder has assigned the DRG and before the bill is dropped. By eliminating the rework of denials through clean claims on the front end, productivity can be increased. Clients benefit from sustainable improvements in CMI, coding accuracy, quality metrics, risk adjustment and physician alignment—with an average return on investment of four to one.”
—Ken Folkman

Q. How can physician-led audits put a health system in a position to provide for a healthier population?

A. “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. This solution not only optimizes reimbursements, reduces denials, and strengthens compliance, it lays the foundation for a population health strategy.”
—John Pitsikoulis

Financial risk has never been greater for health systems, physician-led clinical validation can help minimize this risk and drive revenue recovery with a guaranteed return on investment. Contact us today at 813.324.2107.

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