Quality Management Consulting Group QMCG

  

   QMCG Consultants

Charlene M. Nutter
Director of Audit Compliance Services and
Senior Consultant

Phone:  614.227.4852
Fax:  614.227.2390

Area of Specialization

  • Recovery Audit Contractor (RAC) reviews to include medical necessity audits, along with outpatient claim audits, and MS-DRG reviews
  • Educational programs for physicians/staff on the Recovery Audit Contractor (RAC) program
  • Review of facility charge description master (CDM)
  • Bill audits to assure that the services billed are the services documented in the medical record
  • 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
  • Educational inservices for physicians or hospital staff on ICD-9-CM coding and diagnostic related groups (DRGs)
  • Educational inservices for physicians/staff on Evaluation and Management (E&M) coding

Representative Experience

  • Several years experience in an acute care hospital with management responsibilities in health information management, case management, medical staff services
  • Experience in working with hospital administration, medical staff and Boards of Trustees on billing compliance and quality of care issues
  • Experience in assisting health care facilities in meeting regulatory requirements for billing
  • Consulting with various health care entities on various billing issues
  • Working with fiscal intermediaries to obtain answers to various issues regarding billing and compliance<

Education

  • The Ohio State University
  • Kent State University, School of Nursing
  • American Health Information Management Association Accreditation

Representative Sample of Speeches and Presentations

  • Presentation on Admission Indicator
  • Physician education on Medical Necessity
  • Hospital staff education on Medical Necessity
  • Physician Documentation for Evaluation and Management Coding
  • Presentation on ICD-9-CM Coding
  • Auditing and Monitoring in Your Facility
  • Ambulatory Payment Classifications

Contact Charlene at: cnutter@qmcg.com

   

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