OUR APPROACH

CLEAR PATHWAYS AUDIT

OVERVIEW

The objective of a Clear Pathways Audit is to evaluate outpatient coding accuracy specific to documentation practices and all associated guidelines.  After completely auditing, researching and analyzing all of the documentation contributing to coding/billing/compliance outcomes, Revenix will render summaries, resources and recommendations.  In addition to sharing our findings we will identify areas of opportunities for improved ICD-10-CM diagnosis coding, CPT/HCPCS capture, and documentation within the medical record.  In addition, Revenix will deliver focused education related to all of these results.

REASONING BEHIND AN EXTERNAL AUDIT

1. Impartiality: External audits are completely impartial. The auditors have no previous relationship with the coders or providers at the organization

2. Validation: External audits may provide validation to situations discovered during internal audits

3. Compliance: Audits help ensure medical practices are compliant. They also protect against fraudulent claims and billing activity

4. Revenue Flow: Audits can help increase your revenue flow by ensuring appropriate reimbursement

5. Education: Audits identify educational opportunities for coders and providers. They can also help onboard new coding staff

6. Error Identification: Audits help to identify recurrent coding errors

7. Template or System Irregularities: External audits sometimes reveal potential template or system irregularities, which can easily be corrected

8. Risk Mitigation: Audits serve as a preventative measure to catch potential compliance errors  

GOALS

1. Review medical records for

1. Coding accuracy

2. Proper sequencing of diagnostic and procedural codes

3. Find tangible improvement opportunities

4. Most importantly, all recommendations will be compliant by all Federal/State statutory and regulatory requirements

2. Provide work product with actionable data

1. Reports per provider/specialty regarding coding accuracy affected by documentation opportunities

2. Provide insight on documentation practices/formats that promote autonomous coding workflows and other coding technology that utilizes natural language processing, rules-based A.I. or machine learning

3. Callouts on any potential audit risks or compliance concerns

4. Meet with and provide education and resources where needed or requested by the practice

3. Develop lasting relationships

1. We want to keep in touch and make sure that we are not only providing a service, but we are building a network of like-minded RCM professionals that truly care about improving complex revenue-cycle environments to better serve our providers and patients

SPECIFICATIONS

In preparation for a Clear Pathways audit, Revenix understands that our client will select an agreed upon sample of charts that represents all providers in the group (this will depend on the size of the group or area of interest).  This will be divided and completed over an incremental time period (usually month over month).  The sample can additionally be divided by medical specialty and/or place of service.

Revenix reviews will be conducted offsite but can be performed onsite if that is a requirement.  We request the client grant access to patients’ medical records and/or paper copies of said records that are within the scope of this review.  Prior to review we will test electronic access to the EMR system to ensure charts are available to begin the audit. 

MILESTONES

1. Revenix will follow daily, weekly, monthly or quarterly phases (depending on the size of the audit and needs of the client)

2. Revenix will schedule a status update meeting to discuss any early findings, technical issues or questions/clarifications needed from either side at the end of each phase

3. At the conclusion of the audit final scores and findings will be shared and discussed.  Any education, peer-reviewed support and recommendations will be shared.

Pricing

• We offer competitive and flexible pricing

• While we are just getting started, we can offer legitimately lower cost audits than older/larger companies

• Please reach out today to discuss our offerings!