Medicare Part B Audits

Harmony Healthcare International (HHI) Medicare Part B Audits bring healthcare providers compliance oversight of skilled therapy provision and documentation of reasonable and necessary services.

In-depth medical record review identifies the presence or absence of an accurate representation of therapy coding and associated services billed to the Medicare Part B Contractor.

The healthcare provider must ensure that the Rehabilitation Team has a full working knowledge of OBRA '87, ensuring that every patient is at his/her highest practical state of well being. Functional declines are not acceptable standards of practice. Understanding when the daily skills, knowledge and judgment of a therapist are required is the cornerstone of every solid Medicare Part B Program. This foundation affords each therapist the platform to ensure that beneficiaries are offered care to promote their recovery, maintain their current functional level and prevent decline.

A Quality Care Mission is essential for improved clinical and operational outcomes (Quality Measures, Five-Star Ratings, Regulatory Survey success). In the Post Acute Setting, the Medicare Part B Reimbursement requires a clinically based Rehabilitation Program in Physical, Occupational and Speech-Language Pathology.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) provides an analysis of the Medicare Part B Revenue by discipline and identifies and prioritizes medical records that trigger for a detailed compliance review. In addition, the HealthCARE Specialist will assist the facility with Program Development in alignment with the Quality Care Mission. Harmony Healthcare International (HHI) provides trainings on the requirements of medically necessary rehabilitation for falls prevention, communication, dysphagia, cognition, mobility and ADLs directed from the Medicare Benefit Policy Manual, the Medicare Claims Processing Manual and the State Operations Manual relevant to audit findings.

The Scope of work will include, but not be limited to:

  • Selective Medicare Part B caseload medical record review 
  • Physical, Occupational and Speech-Language Pathology rehabilitation program development 
  • Rehabilitation Documentation Analysis to verify medical necessity
  • Therapy certification (Documentation, Timeliness and Completion) 
  • ICD-10 Coding Review for the purposes of accuracy and consistency with medical records
  • Assistance with Therapy Caps management and Manual Review Management
  • Denial Prevention
  • Functional Limitation G-Codes documentation and billing compliance
  • Written report containing Compliance Analysis, Audit Findings, and Recommendations
  • Follow-up of last visit recommendations
  • Exit conference with Management team to review findings and themes

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