Burden of Care and Medical Necessity Documentation Audit (IRFs)

Objectives

  • Assist rehabilitation providers in closing the documentation gap that leads to discrepancies between burden of care and reimbursement

  • Pinpoint vulnerabilities in hospital documentation that may increase risk of MAC payment denials

  • Identify opportunities for improving documentation and IRF-PAI coding to accurately reflect the burden of care

  • Ensure that documentation proves medical necessity

  • Educate staff and physicians to retain ongoing documentation improvements

  • Develop a strategic plan to secure the reimbursement that matches the care rendered

Process

  • Before we arrive on-site we analyze eRehabData reports and historical data including coding and FIM scoring processes (eRehabData subscribers).

  • On-site we examine the components of the case mix index to determine which of the financial drivers and quality measures are trailing benchmarks through outcomes data review.

  • Armed with that analysis we can effectively assess the care delivery and case management process.

  • Finally, we review the documentation to identify missed reimbursement opportunities due to either inaccurate coding of rehab impairment groups, etiologic diagnoses, or comorbidities, or due to inaccurate FIM scoring.

Deliverables

  • Data analysis with industry comparisons and trends

  • Operational assessment and detailed recommendation for improvement

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