HIM
HIM
MedLearn understands the importance of HIM and the impact that mistakes
in HIM coding can have on a hospital's bottom line. To perform an HIM audit,
MedLearn typically analyzes a sample of MS-DRGs, coding data, medical records,
and UB-04 claims for appropriateness of diagnosis and procedure code selection
using the ICD-9-CM System. Present on admission (POA) indicator assignment
is then assessed using reporting guidelines.
Client Benefits
- Appropriately capture revenue
- Identify risk
- Link medical necessity of services with coding accuracy
- Achieve at least 95% coding accuracy for all coding professionals
MedLearn Approach and Objectives
Physician documentation practices are evaluated against current documentation
guidelines developed by the Centers for Medicare & Medicaid Services
(CMS) in cooperation with regulatory agencies, physician organizations and
HIM associations.
With a typical audit, MedLearn may recommend training for all coding professionals
in order for them to understand MS-DRG assignments, ICD-9-CM coding guidelines,
POA indicator guidelines, coding secondary complicated and co-morbid conditions
and coding to the specificity documented by physicians. We also help with
developing facility-specific policies and procedures, querying the medical
staff regarding any ambiguous documentation, educating the medical staff
and investigating all claim discrepancies by performing pre-bill audits
of claim submissions. MedLearn can assist with a variety of HIM needs and
concerns to help your HIM department function more effectively.
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