Consulting and Support

To assist you in identifying what you need to keep your program ahead of the curve, we conduct a medical record review to assess coding, documentation, query compliance, and post-discharge DRG reconciliation. We conduct a quality data analysis to identify successes and opportunities, meet with staff to gain an understanding of current process, and on-site interviews with key personnel that includes physicians to gain insights into organization dynamics. We then present an assessment report which outlines our findings and recommendations and go-forward plan.

Continuing education for your CDI team and medical staff is vital to the success of your program and stay ahead of the curve. We provide classroom, webinar and hands-on training for your CDI and inpatient coding specialists, physician advisor and medical staff.

Our primary teaching manual is our own CDI Pocket Guide that includes key coding rules and guidelines for correct and compliant coding, evidence based clinical criteria for the key diagnoses that are often missed, and best practice for achieving effective and compliant physician queries.

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Measuring the impact of your CDI program is critical and is measured by more than just your case mix index. We generate CDI performance indicator reports for you or can work with you to develop an in-house solution to capture and report those monthly indicators that measure your successes and identify your improvement opportunities.

Our recovery audit defense and appeals process (both governmental and commercial) is highly successful—we have a 90 percent overturn rate of cases up to the ALJ level that were inappropriately denied by the MAC and QIC. Our appeals approach is evidence-based, incorporating clinical criteria and regulatory requirements in a concise, focused, rapid-response strategy.

We prepare comprehensive responses to RAC, MAC and other auditors designed to maximize the chances of successful reversals as quickly as possible. We identify your denial and recovery audit vulnerabilities and implement corrective action strategies to preempt future assessment risks. We also provide legal expert witness and consultation services for healthcare litigation including Department of Justice, other governmental, and payer audits and investigations.

If you already are or wish to undertake this often challenging process in-house, we can train your staff to effectively review and appeal your cases.