Medical Record Audit
From payers to providers, the quality of today’s health care depends largely on the accuracy and completeness of the medical records generated by clinicians and other health care professionals. Fortunately, HCRS offers third-party medical chart auditing services that are conducted by highly qualified health care professionals in a manner that’s affordable, transparent and, above all, efficient.
Benefits of Medical Auditing
Medical record auditing agencies are contacted by health care organizations for many reasons. Of course, at HCRS — where on average our medical record audits identify $8 in incorrect payments for every $1 invested in our services — our clients typically enjoy the combined results of improved program integrity, delivery of health care and financial well-being.
In many instances, we help providers and organizations operate more efficiently by identifying areas of weakness that can be corrected through training. These areas can include identifying deficiencies in reimbursements, more robust protection against fraudulent claims, correction of poor coding habits and recovery of lost revenue due to insufficient documentation.
Medical Record Review Services
We offer comprehensive, conflict-of-interest-free medical record review services that include coding and diagnosis-related group — or DRG — validation, determination of medical necessity or a complete “complex review” — a solution that includes both.
For coding review operations, we supply inpatient and outpatient coding auditors who are AHIMA-recognized or AAPC certified. In addition, they all have at least five years of coding and two years of auditing experience. For pharma and dental claims, our auditors are pharma techs or dental-certified as well as AHIMA-recognized or AAPC certified.
For clinical review operations, we provide medical necessity determination by means of our nurse auditors, who have a minimum of five years utilization review or audit experience. Additionally, we have two DDSs on call to review dental claims as needed. And our Medical Director — who is Board Certified by the American Board of Quality Assurance and Utilization Review and possesses 15 years of experience as a Medical Director and Senior Medical Director responsible for prior authorization, concurrent review and claims review — personally signs off on all medical necessity denials.
For DRG validation, our specialized experience includes multi-year DRG coding audits and medical necessity reviews for a Recovery Audit Contractor, a hospital physician practice, a Health Management System, a Medicare Administrative Contractor and many more. In addition, we’re experienced at both desk and field audits. Plus, we’re highly skilled at supplying our clients with the following services:
- Obtaining and scanning of records
- Interfacing with customer claims control applications
- Reviewing inpatient, outpatient, pharmacy, dental, behavioral health and other ancillary services coding for both accuracy and sequencing
- Reviewing medical necessity
- Supporting appeals for payer clients as needed
Why Choose HCRS for Medical Record Auditing?
For over two decades, we’ve been helping the full gamut of health care organizations, including non-profits, Defense Department and Veterans Health Administration hospitals, physicians’ groups and state government agencies, a Recovery Audit Contractor (RAC), a Medicare Administrative Contractor (MAC) and a Medicaid Integrity Contractor (MIC). We have — since the beginning of the Audit Medicaid Integrity Program — performed over 1,000 reviews and identified over $20 million in incorrect payments to Medicaid providers.
To learn more about our medical record auditing services and protect the well-being of your organization, your staff and your patients, contact us today.