60% Rule Compliance Optimization Engagement


  • Ensure hospital is not decertified for 60% rule compliance

  • Identify documentation and coding opportunities, given current patient population, to adapt to future compliance methodology

  • Develop an admissions plan that balances census with 60% rule compliance

  • Perform continuous chart audits to ensure future successful compliance reviews


  • Before we arrive on-site we will evaluate current risk for decertification with a review of current compliance including various calculation methodologies.

  • On-site we will evaluate current compliance policies and procedures to determine compliance vulnerabilities.

  • We will perform chart audits on analytically selected "compliance at risk" cases to reveal documentation, coding or compliance classification risks and opportunities for improvement.

  • We will conduct on-site education of staff on 60% Rule subtleties and coding practices for the 2016 rule changes.

  • We will recommend specific documentation strategies for future resistance to audits.

  • We will create facility-specific census development strategies.

  • We will then perform quarterly data monitoring to assess improvement and compliance maintenance.

  • We recommend a 90-day follow up to review implementation of recommendations from initial visit and audit current compliance statistics.


  • Written report on chart audit findings, opportunities, and recommended actions

  • Census development plan

  • Educational materials/resources

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