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
- 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
- ICD-10 training programs
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
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
- Appeals process: QMCG can help you develop winning appeal
arguments to minimize financial losses.
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
QMCG offers a variety of audit and compliance services for
physicians' offices, including claims review and education
- 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.
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.