Audits within Health Information Management (HIM) offer insight into quality, compliance and opportunities for operational and financial improvement.
Coding Quality Audits
An uncomplicated way to assist medical coders in their continued growth and development is to provide them with regular, on-going feedback regarding the accuracy of their work through auditing. JTS' Coding Quality Audit provides coders with this information then offers education and training opportunities specific to the coder’s needs. JTS’ post-audit opportunities are directed toward education and are customized to the coder’s educational needs identified during the audit. We provide coders with individualized training and education in a spirit of cooperation that promotes learning and improvement in accuracy.
Are you leveraging the information in your Program for Evaluating Payment Patterns Electronic Report (PEPPER) from the Centers for Medicare and Medicaid Services (CMS) report to improve services? JTS can collaborate to create an audit tailored to the needs of your organization. The end result is information that can be used to identify and manage risks.
Reducing the risk of retrospective third-party audits in another type of auditing service that JTS provides by developing a custom audit. Audit results can be used to improve coding compliance and reimbursement.
Charge Capture Audits
A JTS Charge Capture audit identifies areas of lost revenue due to missed charges or incomplete/ inaccurate coding and reveals opportunities for improvement. By thoroughly understanding your current state, necessary changes for both compliance and financial improvement can be easily identified.
nCREAS™ | Analytics as a Service
Coding quality audits are a valuable tool for educating both physicians and coders in an effort to improve coding quality, compliance and reimbursement. However, the sample sizes in typical audits are frequently insufficient to identify problematic patterns that result in lost revenue.
JTS developed an automated, targeted DRG, patent-pending, nCREAS™ analytics solution that pinpoints specific types of coding to assess the extent to which revenue is lost to incomplete or inaccurate coding. In near real time, nCREAS™ scans coding based on the DRG which eliminates the set sample size, providing more accurate auding results.
CC/MCC Capture Rate Audit
The complication or comorbidity (CC) or a major complication or comorbidity (MCC) capture rate is the percentage of discharged patients that have a CC/MCC as compared with the CMS benchmarks. JTS’ nCREAS™ platform compares your organization’s data to the CMS benchmarks to automatically determine in the documentation is present to support the MS-DRG. These basic metrics can often be provided by the system utilized in the hospital, but without understanding how they are derived, it is difficult to make improvements. Using nCREAS’ CC/MCC audits, continual compliance improvement will sustain enhancement and limit risks of potential CMS audits.
Audit for Success
Audits can be a time-consuming endeavor for a hospital or healthcare system to tackle on their own. However, they are necessary to prevent denials, improve coding quality and ensure ongoing coding compliance. JTS’ unique approach to auditing focuses on analysis, hands-on education, measured improvement, and ongoing risk management which improves sustainability. Partnering with the experts at JTS Health Partners to conduct your audit will uncover opportunities for operational and financial success.