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Revenue Cycle

Fraud & Forensics|Risk & Compliance

Charge Description Master (CDM) Reviews

We offer both quarterly and annual CDM reviews that will provide a solid foundation for optimal charge capture and compliant billing.  Our comprehensive CDM reviews are performed by our certified coding and healthcare compliance experts and are designed to ensure the accuracy and completeness of the services within the CDM to capture revenue opportunities and reduce compliance risk.  Additionally, we evaluate pricing to identify services with charges below the Medicare allowable or those that are excessively priced in an effort to fully capture allowable reimbursement while minimizing risk.

Billing Performance Reviews

Our team of experts will perform a review of the entire billing process to confirm accuracy and efficiency at all crucial points.  Using detailed analysis of key billing reports, employee interviews and sample account detail reviews, we compare the organization’s performance to national recognized industry standards and objectively identify areas of risk and opportunity.

Denial Management Reviews

We offer monthly, quarterly, or annual denial management reviews.  These reviews are designed to identify trends and opportunities for operational performance improvements.  We will provide detailed reports outlining the findings, risks and recommendations for process improvement to reduce denials, lost revenues and compliance risk and improve financial performance.

Documentation, Coding and Billing Reviews

We have a team of certified coding experts who perform outpatient and inpatient documentation and coding reviews to evaluate the quality of medical record documentation to support accurate and specific procedure and diagnosis coding as well as the accuracy of the assigned codes.  You will be provided with a detailed report identifying any potential risk areas as well as documentation and charge capture opportunities.  These reviews can be performed on an as needed basis or as part of the regular compliance program auditing process.  We also perform shadow auditing services as part of your ongoing education and training efforts.

Customized Education and Training

We offer customized education and training to coding, billing, clinical and administrative staff based on the unique needs identified internally or the specific findings discovered through one of our review services.  Every educational session is designed to be interactive and incorporates meaningful case examples.  We have the capabilities to provide these sessions through teleconference, web conference, or in person based on your needs.

Policy and Procedure Review and Development

Our team of experts is available to work with you to revise or develop policies and procedures based on the individualized needs and risks of your organization.  We work in collaboration with your staff to prepare necessary policies and procedures to reduce compliance risk and optimize operational performance.

Support Services

We offer monthly service and support packages to provide our clients with authoritative guidance to their documentation, coding, coverage and billing questions.  We provide written responses with corresponding citations within 2 business days to allow timely resolution of any questions or concerns our clients may have and prevent unnecessary delays to the revenue cycle process.