Program Integrity

We Specialize in Medical Record Integrity Services – Dependable, Responsive, Affordable

HCRS believes that we are just at the beginning of an era of relentless pressure on payers and providers alike to squeeze incorrect payments out of healthcare. Accurate coding and medical record documentation have never been more important than they are today. HCRS provides:

• Expert coding services, on-site or remote, all settings, all specialties. Our coding clients currently include payers, consulting firms, and research organizations.
• Expert training in coding and documentation. Since 2001, we have provided thousands of hours of coding and documentation training to coders and clinical staff at  hospitals across
  the country.
• Medical record audit, on-site or remote, all settings, all specialties. We are a “complex review” subcontractor performing coding, and/or medical necessity review. Some representative clients:
• CMS Audit Medicaid Integrity Contractor. Between 2008-2013, as a subcontractor to IntegriGuard, a Medicaid Integrity Contractor (MIC), we performed MIC coding and medical necessity validation in 19 states and three territories west of the Mississippi. During that period, HCRS conducted over 1,300 MIC complex audits (desk and field audits) and identified more than $26,000.000 in incorrect payments.
  • Medicaid programs: Coding validation and medical necessity review in the states of Virginia and Maryland.
  • Medicare: Assisting a Medicare Administrative Contractor (MAC) with audits and re-adjudication for the Comprehensive Error Rate Testing (CERT) program, Evaluation and Management (E&M) coding and an independent review for reopened claims.