A total of $1.03 Billion have been recovered by Medicare in the demo phase of RAC Audit (2005 - 2008). The RAC audits are growing into one of the biggest financial challenges and administrative burdens for healthcare sector across the nation as in the Tax Relief and Health Care Act of 2006, the RAC program was made permanent and the Centers for Medicare & Medicaid Services (CMS) was mandated to roll out the program to all 50 states by 2010.

This emphasizes the need for accurate documentation of clinical data and submission of claims with correct coding conventions as per CCI edits, OCE edits & other parameters. The Code Review and Audit ensures verification of medical records for these standards of documentation and appropriate coding for services rendered by providers.

How can Data Marshall Help?

The 'Code Review & Audit' services offered by Data Marshall ensure correct coding and capturing of all services rendered in different types of Outpatient settings, and facilitates the identification of missed charges which were not coded by coding staff or not captured by Charge Description Master.

These services are intended to identify and reduce billing and coding errors, cost-shifting practices, fraud and abuse after the claims have been paid, but prior to a RAC audit. These audit services ensure that the diagnosis codes, procedure codes and DRG's are accurate, valid and sequenced in accordance with national coding standards.

Our Approach

• Hospital Outpatients
  • Emergency Deptartment
  • Ambulatory Surgery Center
  • Observation
• Office/Clinic
• Nursing Facility

• To validate the assigned codes and ensure codes are as per the National Coding Standards.
• To ensure that all services performed are captured and processed correctly by checking modifiers, add on codes and missed charges.
• To ensure that services are reimbursed properly by the payers.

Benefits

• 40 - 50 % Cost Savings
• Higher Payment ($) realization through proper Coding Techniques.
• Ensure compliant based coding in order to reduce denials.
• Regular Performance Reporting emphasizing the areas of Improvement.

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