Medicare Part A Audits
Harmony Healthcare International (HHI) Medicare Part A Audits bring healthcare providers compliance oversight of MDS generated RUG data reviewing for billing accuracy.
An in-depth medical record review promotes precise MDS/PPS coding, as well as documentation review of supporting skilled Medicare coverage criteria. Audits hone in on ADL support provided, skilled therapy services, mood indicators, and diagnosis coding.
In the Post Acute Setting, Medicare Part A reimbursement is undergoing significant changes in the upcoming years. Currently, payment is reliant on complex scheduling and completion of the Minimum Data Set (MDS) assessments multiple times within the 100 day benefit period. The MDS is used to classify patients into Resource Utilization Groups (RUGs), which results in a score; each RUG score represents both rehabilitation and nursing components of the care and services provided. Precise scoring of the MDS assessment is critical to ensure the appropriate representation of the clinical condition and services rendered to the patient.
How can Harmony Healthcare International (HHI) help?
On a monthly basis, Harmony Healthcare International (HHI) provides an analysis of the Medicare Part A services review for MDS/Billing errors, compliance issues or missed reimbursement opportunities, and facilitates appropriate corrections and rebilling. Harmony Healthcare International (HHI) provides education directed from the Medicare Benefit Policy Manual, the Medicare Claims Processing Manual, the State Operations Manual, and the Resident Assessment Instrument Manual that is pertinent to our customer's area of focus.
The scope of work will include, but not be limited to:
- Selective Medicare Part A caseload review for MDS Coding Accuracy to verify that coding supports the level of care documented
- Proactive case management of upcoming assessments
- Individualized Patient Medical Record Review & Analysis based on a sample of claims selected for audit
- Therapy Documentation Analysis to verify medical necessity
- Nursing Documentation Analysis to verify medical necessity • Review of Medicare skilled coverage criteria
- Selective UB-04 Reviews for completeness of technical elements of billing
- ICD-10 Coding Review for the purposes of accuracy and consistency with medical record
- Medicare Part A Revenue RUG Analysis
- Written report containing Compliance Analysis, Audit Findings, Error Percentage, and Recommendations
- Follow-up of last visit recommendations
- Exit conference with Management team to review findings and themes