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QMCG Consultants
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Melanie G. Allen
Director of Audit Compliance Services and
Senior Consultant
Phone: 614.227.4852
Fax: 614.227.2390
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Area of Specialization
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Recovery Audit Contractor (RAC) reviews to include medical necessity audits,
along with outpatient claim audits, and MS-DRG reviews
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Educational programs for physicians/staff on the Recovery Audit Contractor
(RAC) program
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Review of facility charge description master (CDM)
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Bill audits to assure that the services billed are the services documented in
the medical record
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ICD-9-CM coding review and DRG review for hospitals (inpatient acute care,
specialty hospitals), outpatient surgeries, outpatient diagnostic testing and
therapeutic services. Home health, hospice, skilled nursing facilities bill
reviews
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Educational inservices for physicians or hospital staff on ICD-9-CM coding and
diagnostic related groups (DRGs)
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Educational inservices for physicians/staff on Evaluation and Management
(E&M) coding
Representative Experience
- Over 20 years experience in an acute care hospital with management
responsibilities in health information management, revenue cycle management, and coding education
- Recent experience in the RAC appeal process, specializing in MS-DRG denials
- Experience in assisting health care facilities in meeting regulatory requirements for billing and coding
- Consulting with various health care entities on various billing issues
- Working with fiscal intermediaries to obtain answers to various issues regarding billing and compliance
- Working with Southwestern Schools as a Medical Coding and Billing instructor in their adult education program.
Education
- Hocking College
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Ohio Dominican University, currently pursuing degree in Cross-Disciplinary Studies
- American Health Information Management Association Accreditation
- Registered Health Information Technician
- Certified Coding Specialist
Representative Sample of Speeches and Presentations
- RAC issues affecting acute care facilities programs
- Clinical Documentation Improvement and RAC
- ICD-9 Coding Updates – Moving Toward ICD-10
- Basic Billing & Coding for Physicians
- Hospital Acquired Conditions and Patient Safety Indicators
- Present on Admission Indicators
- Back to Basics – A Coding Review
Contact Melanie at: mallen@qmcg.com
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