Billing and Coding

Harmony HealthCARE Specialists review the RUG Classification obtained on the MDS 3.0 as a guide when auditing the associated medical record to affirm that the level of care and skilled services provided equate to the RUG-IV score billed on the claim.

The RUG level (Resource Utilization Group) attained is representative of the resources necessary to provide care for the resident, within the Post-Acute and Long Term Care environments. Harmony Healthcare International (HHI) will provide an analysis of the Medicare Part A services review for MDS/Billing errors, compliance issues and reimbursement opportunities, and facilitate appropriate corrections and rebilling. Harmony Healthcare International (HHI) will provide education directed from the Medicare Benefit Policy Manual, the Medicare Claims Processing Manual, the State Operations Manual, and the Resident Assessment Instrument Manual that may be pertinent to the issues identified.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) billing reviews provide focused oversight by evaluating the business office procedures for accuracy with Medicare Part A and Medicaid claims. The Harmony Healthcare International (HHI) process includes review of UB-04 claims, interviews with billing personnel as well as work flow responsibilities and data audit/analysis.

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