“Am I at risk?” This question comes up so often when I am approached at conferences by practice managers and physicians. Many in the healthcare industry have a sense of dread when thinking about what could happen if they are targeted for a government audit intent on searching out healthcare noncompliance, fraud, and abuse. This fear, in even the most careful providers and managers, is why every organization needs to have a periodic compliance checkup.
You can identify if you are at risk of falling into compliance traps by being proactive. If an outside entity such as TCI identifies errors, you will have time to remedy any issues before you catch the attention of CMS. And if you are on the right path, having an outside eye can provide you with much needed assurance, providing solid proof that you take compliance seriously and take steps to optimize reimbursement.
How TCI Can Help
Once you’ve decided to have an outside expert take a look into your coding and documentation processes, it’s important to find the right fit for your needs. I’ve included some examples of issues below along with which of TCI’s comprehensive revenue cycle management services I’d recommend to assist with that specific need.
Problem 1: Revenue Loss Due to Inefficient RCM
Our revenue cycle management solutions can offer comprehensive revenue cycle management or specific areas of RCM. If you have a problem with claims rejecting at the clearinghouse level, TCI can provide scrubbing assistance and even provide the services such as demographic entry and billing to eliminate the rejections. Are you having difficulties with timely claim submission due to limited staff? TCI can also streamline coding and billing solutions with daily claims submission, which would reel in a continuous stream of revenue.
Our experts can recognize if and where your practice is losing hard-earned revenue. Our risk management services can pinpoint any compliance hot-spots before they become a major problem. You’ll receive top of the line legal and regulatory compliance advice which would allow you to take immediate action in protecting your organization from fraud and abuse investigations. You can even integrate your practice management system directly with TCI’s system and receive real-time management and oversight of your claims.
Problem 2: Generic Training with Poor ROI
TCI’s customized training provides you with the benefit of tailoring education, both online and onsite, to your organization’s specific needs. Do you need specialty specific education? TCI can tailor training sessions to include specific services or subject matter that would best benefit your organization. Small coding and compliance errors can lead to expensive problems. Our practical and proven training strategies will ensure that your coders and clinicians take away the knowledge to perform their jobs effectively and accurately.
Problem 3: No Strategy for Improving Documentation and Coding
TCI’s chart auditing services, which is where I come in, follow a proven three-step method that can be customizable to your individual needs. Are you seeing an increase in coding denials? We provide a team of certified consultants, trainers, and experts to identify specific areas of improvement. TCI can assist you in establishing benchmarks to correct any areas of improvement and establish goals and strategies so that you will be on the right path to compliance. A documentation and coding review allows us to evaluate your coding accuracy, identify any compliance red flags, and common EMR pitfalls. You’ll receive results and analysis that reveal the financial impact of errors while detailing steps to improve your accuracy. One-on-one education sessions are also provided post-audit to answer any questions and explain your results.
TCI Cares About Your Bottom Line
While each client is different, some of the common issues we identify in chart audits include incorrect modifier usage, overcoding and undercoding of evaluation and management codes, unbundling issues, and documentation issues such as cloning and improper copy and paste. All of these issues will cause a financial impact to your organization’s bottom line.
Coming from a background of managing all aspects of the medical practice before I took on a more centralized role as an auditor, I respect and understand all of the hard work that providers put into their organizations and all of the hard work they put into their patients’ care. My job as an auditor is not to find errors just for the sake of finding errors, but to effectively boost your compliance and coding by providing tools and resources for improvement. I have found that most providers and senior executives want to stay off CMS’s radar. They ultimately want to do the right thing with compliance and coding, but they also want to ensure the organization succeeds financially in the process. You can certainly do both with the right guidance, and TCI can help with that.
Why I love what I do: One of the most rewarding aspects of my job as an auditor is seeing the improvement in a client’s documentation and coding from audit to audit. I have found that most providers, after the initial distress of hearing the word “audit,” are very open to learning how to improve their documentation and code selection.
As a matter of fact, one of our long-time audit clients has steadily increased in accuracy since 2015 when we first took them on as a client. The initial overall audit score for the group was in the low 50 percentiles and even just a short year later, the overall score was in the high 80s. In fact, now, most of the providers are reaching 100 percent accuracy. These types of results are achieved from outlining specific areas of improvement, providing the education on how to improve those areas, and working with the providers to implement the changes.
Meet Our Team
TCI will be exhibiting this year at MGMA’s Annual Conference on October 8-10. I will be in attendance as a product expert to answer any auditing questions that you may have. In the meantime, take some time to think about what questions you may have pertaining to any of our product offerings and even areas that you may like to see improved in your organization. Stop by and let us know what challenges you are facing, and we’ll explain how TCI can help. Hope to see at the conference!