Inpatient Audit Services
- Inpatient Audit Services
- Medical Necessity of Inpatient Admission
- Inpatient DRG for Psychiatric Services
- Long Term Acute Care (LTAC) PPS
- Swing Bed Reimbursement
ACS consultants provide MS-DRG audits as well as review for APR-DRGs. Our team of expert credentialed coding consultants provide coding audits for DRG accuracy with an emphasis on education. Inpatient audit services include:
- Prebilling review of coding accuracy and documentation adequacy to assure the hospital receives the optimum reimbursement to which they are legally entitled;
- Retrospective review options, from data-driven samples to identify underpayment or overpayment potential, random samples, or samples stratified by coder to support the hospital’s coding compliance audit initiatives. Retrospective reviews include evaluation of coding accuracy, DRG optimization, accuracy of discharge status codes and POA (present on admission) indicators;
- Concurrent review alongside the hospital’s clinical documentation specialists to assure effectiveness of the concurrent query process;
- APR-DRG reviews include an assessment of reimbursement accuracy as well as an evaluation of both severity of illness and risk of mortality.
ACS consultation for one-day stay review is designed to target the Medicare population and includes an analysis of the hospital's PEPPER report as well as data from the hospital's information system. On-site consultation services include record review to evaluate compliance with admission screening criteria, adequacy of physician documentation and accuracy of DRG assignment. This review is followed by education with case managers and coders as well as an exit conference for hospital leadership. A detailed report of findings along with report graphics will be provided following the on-site consultation.
ACS consultation for inpatient psychiatric facilities is designed to target the Medicare population whose claims are reimbursed under the new Prospective Payment System. On-site consultation services include medical record review to evaluate the adequacy of physician documentation, and accuracy of coding to assure optimal DRG reimbursement assignment and capture of CC's. The consultation includes education for the psychiatrists, consulting physicians, behavioral health staff, and coders, as well as an exit conference for hospital leadership. A detailed written report of findings and recommendations for improvement will be provided following the on-site consultation.
By law, CMS pays long-term care hospitals under the LTCH Prosective Payment System. These prospective payment systems establish prospectively set rates based on the patient’s diagnosis and the severity of the patient’s medical condition.
In FY 2008, CMS replaced the 538 DRGs with 745 Medicare-severity DRGs (MS-DRGs) which provide higher payment for more severely ill or injured patients and lower payment for all other cases. In FY 2009, Medicare created an additional MS-DRG bringing the total to 746.
Administrative Consultant Service, LLC provides audit and educational services to assist LTAC’s achieve accurate and optimal reimbursement through improved documentation by the provider and coding accuracy.
Consultation services include:
- Data analysis to benchmark the hospital rate of assignment to high volume, high risk and problem prone MS-DRGs.
- Chart review to evaluate documentation adequacy, coding and billing accuracy
- Review of ICD-9-CM Coding Policies and Procedures
- Education for the coding staff and medical staff
- Implementation of an Effective Clinical Documentation Improvement Program
- Preparation of appeals due to MAC, RAC, CERT or other proposed MS-DRG changes or medical necessity of admission denials.
Compliance with Medicare Conditions of Participation for implementing a Swing Bed program is easier than you think! Since 1985 Administrative Consultant Service, LLC has assisted hospital with the required policies and procedures and staff education resulting in a very short turnaround time for achieving readiness for State Health Department survey!
Swing Bed Consultation Services include:
- Interview with Hospital Staff to identify existing programs and staff needed for provision of Swing Bed care
- Development of hospital specific Policies and Procedures compliant with Medicare Conditions of Participation
- Staff education regarding appropriate use of Swing Bed
- Staff education regarding accurate billing for Swing Bed services
- Follow-up compliance audits to evaluate appropriateness of Swing Bed use and accuracy of Swing Bed billing.