Audit & Education Services

QMCG can help your organization navigate the complicated world of audits and billing in the health care industry. Costs and regulatory scrutiny are on the rise, making it more important than ever to make sure your organization is doing things right.

QMCG's professional relationship with the health care law firm Bricker & Eckler LLP can provide our consulting clients with attorney-client privilege to protect any findings.

Our experts will review your billing processes to make sure your organization is keeping current with payer regulations while maintaining efficiencies in your billing processes with a variety of services:

• Recovery Auditor Program Education, including pre-review audits, denials management and appeals
• Hospital support, both onsite and remote
• Physician support, including claim review and staff education
• ICD-10 training programs

Recovery Auditor Program Education

All hospitals and physician practices that bill Medicare Parts A and B are subject to the federal government's recovery auditor program to ensure the facilities are properly billing the government for their services. Two years of Recovery Auditor Contract (RAC) activity revealed target issues for facilities and physicians.

QMCG will help your facility minimize the risks associated with RAC issues utilizing:

• Pre-review audits: QMCG can help minimize your risk and maintain revenue with proactive audits focused on current RAC issues. QMCG will identify areas of vulnerability at your facility and correct them through education.
• Denials management: QMCG will help your facility develop policies and procedures to manage denials in a timely manner. These policies and procedures are critical for Medicare's non-negotiable timelines and are essential to the success of addressing any RAC offense.
• Appeals process: QMCG can help you develop winning appeal arguments to minimize financial losses.

Hospital Support

QMCG tailors the review to the needs of your facility by offering both onsite and remote review of your charge master and selected cases for audit.

• Charge Description Master Review: Charge capture from a clean, up-to-date charge master is a key component of a successful revenue cycle. QMCG's line-item analysis of each hospital department ensures regulatory compliance and financial improvement.
• Inpatient Coding Audits: Audits of coding practices for accuracy and consistency often reveal room for improvement and a need for education. QMCG experts review and provide best practices for inpatient coding based on current Official Coding and Reporting Guidelines and Coding Clinic resources.
• Diagnosis Related Group Review Audits: Diagnosis related group (DRG) audits can identify both coding issues and physician documentation problems. Appropriate sequencing and DRG grouping affect the case mix index and ensure accurate reimbursement. QMCG will identify admission errors, inaccurate post-acute transfer discharge status and hospital-acquired conditions that contribute to the facility's quality of care public profile.
• Outpatient Claims Review Audits: QMCG will audit your outpatient prospective payment issues to keep your facility up-to-date on regulatory and billing guidelines that change daily. Our consultants will clarify current rules for observation status, medical necessity, infusions and injections, and other outpatient prospective payment system concerns.

Physician Support

QMCG offers a variety of audit and compliance services for physicians' offices, including claims review and education programming:

• Claims Review: A QMCG review of claims and comparisons with supporting physician documentation can provide an accurate picture of individual physician billing and can reveal the presence or absence of the bell curve suggested by the Centers for Medicare & Medicaid Services.
• Physician and Staff Education: Education and training on current coding, billing and regulatory resources issues enhance compliance and assure optimal reimbursement.
• Evaluation/Management (E/M) Level Audits: QMCG can help increase your facility's reimbursement and compliance by fostering a clear understanding of E/M services and key components of levels of care and associated reimbursement.

ICD-10 Training Programs

QMCG is available to lead training programs at physicians' offices, hospitals, home health agencies, long-term care facilities, behavioral health practices and other organizations to assist in the transition to ICD-10. Training will be provided by a certified ICD-10 trainer with experience in adult education.