While a Hospital or Clinic Chargemaster may be accurate and maintained in a compliant manner, there is a complex integration process involved throughout the documentation of order entry, HIM code application within the Electronic Medical Record (EMR) to the Billing System and edits involved through the actual billing process. Issues may result from order entry items not linked to the chargemaster line item and edits that strip CPT/HCPCS or unbundle codes due to a lack of NCCI edits in the facility billing system. These “broken links” may result in missed charge opportunities or overbilling compliance issues.  RIMR offers a complete review by our certified coders to audit the entire process from start to finish. 

 

RIMR offers a complete Charge Capture Review of 30 outpatient encounters by our certified outpatient coders through an audit of the EMR patient encounter, Patient Itemized Statement and associated UB04 or HCFA1500.  

Complete audit of 30 outpatient service encounters of various insurance types which are often found to have under-billed drug units or missing services or surgical supply HCPCS. RIMR reviews the accuracy of CPT, HCPCS, Revenue Codes based on current American Medical Association (AMA) coding guidelines and Medicare’s National Correct Coding Initiative (NCCI) guidelines.  The patient encounter/EMR is reviewed against the patient Itemized Statement to UB04 or HCFA 1500. Facilities may request a higher volume percentage of those departments experiencing insurance denials relative to CPT, HCPCS, Revenue Codes or Drug dosages. 

Types of encounters include:

  • Outpatient Blood Transfusion

  • Observation 

  • ER to Observation

  • Outpatient nursing visits

  • Radiology 

  • Obstetrics 

  • Emergency Room

  • Operating Room

  • Wound Care

  • Pain Clinic

  • PT/OT/ST

  • Oncology

  • Radiation Therapy


Results are reviewed with the Hospital or Clinic HIM, PFS, CFO, Revenue Cycle Manager, CDM Coordinator and IT staff via telephonic presentation of findings within 45 – 60 days to discuss issues identified and the department affected. RIMR will assist in providing Medicare Coding guidance, and Educational Webinars to Nursing or Coding staff on topics such as Infusion & Injections, Patient Status (Observation) as needed.