Skyrocketing costs and the healthcare reform mandates have demanded the need for transformation of the US healthcare ecosystem. To assist our clients meet these challenges, we have developed a suite of Value Added Services, which include:
Our services help our clients improve the accuracy of clinical documentation and DRG coding through the coordinated efforts of Caregivers, Physicians and Coding professionals, guided by experienced e4e consultants.
Our Inpatient Coding Validation services provide comprehensive reviews to assess DRG code assignments, improve documentation, and quantify the impact of coding changes.
These services help our clients sustain the benefits of DRG Assurance with leave-behind software that provides guidelines for concurrent chart review and identifies potential compliance risks, frequently missed concepts, and issues with working DRGs and ICD-10 code.
Our services conduct focused assessments of HIM workflow challenges, staffing, and performance improvement needs. Our recommendations identify ways to manage medical records and improve healthcare delivery, billing, revenue cycle, outcomes reporting, release of information, and issues with DRGs and ICD-10 codes.
Medicare's Recovery Audit Contractors (RACs) have become a standard requirement lately and our expertise in this domain can help you be prepared. We identify and quantify the financial risks posed by the RAC program through a data-driven approach. We focus only on issues and specific accounts with the highest probability of coding, billing and documentation errors. Our RAC audit engine can run checks on your entire data instead of just random sampling of a few claims. Thereafter, we work with you to mitigate the identified risks, to better manage the process, and to stop losing Medicare revenue. We provide:
- RAC risk assessments
- Transaction auditing of targeted, hospital-specific MS-DRG, hospital outpatient, and physician service accounts
- Support in deployment of RAC management programs
A Windows-based, web application that besides enabling DRG audit, is also designed with data scrubbing capability using Medicare edits and rules to identify potential incorrect payments.
Our Medical Record Audit services include:
- Professional audit
Identifies improper current procedural terminology coding, ICD coding, and billing errors to eliminate over and under payments and improve revenue optimization for both providers and plans.
- Hospital audit
Identifies inpatient and outpatient claims with coding and billing errors. These are screened for coding errors due to potential up-coding, down-coding, diagnosis sequencing errors, place of service issues, DRG creep, unbundling, and case rate violations.
It is imperative for a health plan to measure its quality of care to better evaluate the level of service the providers in their network deliver, identify gaps and make appropriate changes to ensure continued member satisfaction and loyalty.
Health plans widely use the Healthcare Effectiveness Data and Information Set (HEDIS) to measure and report on quality of care.
At e4e, our certified coders abstract medical data accurately and deliver the results back to the health plan or vendor to maximize HEDIS rates for hybrid measures.
e4e also leverages its experienced Risk Adjustment Audit teams to abstract HEDIS measures during the HCC Chart Review process itself. This service allows our clients to capture important risk adjustment and HEDIS data at the same time for improving RAF scores and quality of care measures.