Medical Necessity Documentation Audit

The last few years have brought great challenges to the inpatient rehabilitation field. The newest one? Medicare Audits, which require us to justify the care we provide with detailed documentation. Identifying the steps to meet growing documentation requirements may seem an impossible task. Fleming-Advanced Outcomes Design Consulting can help you with clear solutions that minimize the questioning and instead focus your energy on easy-to-implement procedures to get you on the right path.

Fleming-Advanced Outcomes Design Consulting's Medical Necessity Documentation Audit helps rehabilitation providers resolve discrepancies between care rendered and care recorded using careful documentation review. In this audit we analyze hospital operations, identify opportunities to improve documentation and IRF-PAI coding to reflect the burden of care, ensure that documentation proves medical necessity, educate your staff and physicians, and develop procedures that support these goals over time.

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 an operational assessment and detailed recommendation for improvement.

Step Three – Records review

• Assess documentation to determine strengths and identify missed opportunities due to lack of medical necessity, inaccurate coding of Rehab Impairment Groups, etiologic diagnoses, comorbidities, or inaccurate scoring of functional measures.

Pricing: The cost of this comprehensive service is about the same as the reimbursement on only two additional discharges and, 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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