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60% Rule Compliance Optimization Engagement
Objectives
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
Process
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.
Deliverables
Written report on chart audit findings, opportunities,
and recommended actions Census development plan Educational materials/resources
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