Burden of Care Documentation Audit

Rehabilitation Hospitals have come under increased financial pressure in the last three years. The 75% rule has decreased occupancy while increasing the average acuity of patients in rehabilitation hospitals. This shift towards more expensive patients is often not fully captured in the IRF-PAI data leaving a gap between the burden of care and the reimbursement paid for those patients.

Fleming-Advanced Outcomes Design Consulting has developed a consulting product to assist rehabilitation providers in closing the documentation gap that leads to discrepancies between burden of care and reimbursement. We assist clients by analyzing the hospital operations, determining where opportunities exist to improve documentation and IRF-PAI coding to accurately reflect the burden of care, ensuring that documentation proves medical necessity, educating your staff and physicians, and developing a strategic plan to capture the reimbursement that matches the care rendered.

This service is a three-step process:

Step One – Assess the components of the case mix index to determine which of the financial drivers and quality measures are trailing benchmarks through outcomes data review

• Analyze eRehabData reports and historical data
• Deliver data analysis with industry comparisons and trends

Step Two – Operational review

• Assess the coding and FIM scoring process
• Assess the care delivery and case management process
• Deliver a operational assessment and detailed recommendation for improvement

Step Three – Records review

• Assess documentation to determine missing reimbursement opportunity due to either inaccurate coding of Rehab Impairment Groups, etiologic diagnoses, comorbidities or due to inaccurate scoring of FIMs.

Our clients report:

• "We will realize an additional $879,000 this year thanks to better coding and patient selection."

• "We have captured an additional $1,076 per discharge since our engagement."

• "Our case mix index increased from 1.1166 to 1.2818 adding $1,782 reimbursement to each discharge."

Pricing: The cost of this comprehensive service often equals the reimbursement on only two additional discharges. In most cases, you will have sustainable improvements in case mix index which will continue to provide a significant return on this investment.

Contact Lisa Werner at (240) 386-7876 or email  lwerner [at] aod.cx  to begin the process.

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