Medicare Coding Audit & Compliance
The coding consultants of IHI provide a range of coding compliance and regulatory services designed to help your organization maintain compliance with various industry standards, including: AHIMA, CMS, AMA, NCVHS and AHA. Our customized audits are tailored to meet the specific needs of each client situation, so you get the focused recommendations necessary to achieve your goals.
IHI’s audits evaluate data quality, coding compliance and documentation to improve confidence in accurate coding and grouping. A formal detailed report of findings will be presented promptly, usually within just 15 business days.
We can help you identify areas of risk in your coding process, make recommendations and provide education to help with compliance.
Benefits of IHI’s Audit and Compliance Services
- Improve compliance with coding guidelines and regulations
- Allow you to meet the OIG requirement for at least annual auditing of coding
- Improve case mix index accuracy
- Lower denials and rejections
- Improve hospital and physician profiling and score card data
- Offer education and training to improve skill set for current coding staff
- Prepare facility for future reimbursement systems
Medicare Medical Necessity Review and Compliance
IHI Physicians work with case management and the attending physicians to review Medicare admissions and apply medical necessity definitions, medical judgment, and CMS regulations to determine and document Medicare admission claim status regarding all Medicare admissions that do not meet initial case management admission screening using admission criteria (such as Interqual or Milliman). IHI will review all such cases, issue a final utilization review determination regarding admission status, and provide individualized case documentation supporting the decided upon level of care.
- Benefits of IHI’s Medical Necessity Review and Compliance Services
- Improve compliance with payor regulations
- Helps comply with corporate integrity agreements
- Identifies RAC audit risk
- Lower denials and rejections
- Helps with physician education and CDI efforts