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Burden of Care and Medical Necessity Documentation Audit (IRFs)
Objectives
Assist rehabilitation providers in closing the documentation
gap that leads to discrepancies between burden of care and
reimbursement Pinpoint vulnerabilities in hospital documentation that may
increase risk of MAC payment denials Identify opportunities for improving documentation
and IRF-PAI coding to accurately reflect the burden of care Ensure that documentation proves medical necessity Educate staff and physicians to retain ongoing
documentation improvements Develop a strategic plan to secure the reimbursement
that matches the care rendered
Process
Before we arrive on-site we analyze eRehabData reports and
historical data including coding and functional scoring processes (eRehabData subscribers). On-site we examine the components of the case mix index
to determine which of the financial drivers and quality measures
are trailing benchmarks through outcomes data review. Armed with that analysis we can effectively assess the care delivery
and case management process. Finally, we review the documentation to identify missed
reimbursement opportunities due to either inaccurate coding
of rehab impairment groups, etiologic diagnoses, or comorbidities,
or due to inaccurate functional scoring.
Deliverables
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