Compliance and Audits

To achieve quality in health care, we need to ensure we have complete and accurate data in the medical record. Diskriter provides medical coding audit services to help our clients ensure their clinical documentation systems and processes are supporting effective revenue cycle management. Our programs also help our clients ensure compliance with the myriad of legal medical coding compliance requirements including JCAHO, ARRA, HIPAA, HITECH, and other national and state regulations.

Through our Clinical Coding Audit program, we help our clients in the following ways.

  • Ensure medical coding compliance with legal and regulatory requirement
  • Identify fraudulent claims and billing activity
  • Prepare for recovery medical coding audit contractors (RAC)
  • Uncover reimbursement deficiencies
  • Address process improvement opportunities
  • Compare clinical document metrics to industry standards

RAC Assessment + Preparation (Acute Care)

What are they looking for?
  • Codes fully supported by documentation?
  • Medical Coding Audits assigned appropriately?
  • Have the following issues been billed correctly?
    • Blood transfusions
    • Untimed Codes
    • IV Hydration Therapy
    • Bronchoscopy Services
    • Once-in-a-lifetime Procedures
    • Pediatric Codes Exceeding Age Parameters
    • J2505 (Injection, Pegfilgrastim, 6 mg)

RAC Assessment + Preparation (Rehabilitation)

What are they looking for?
  • Discharge disposition accurately abstracted?
  • Clinical Coding audits amply supported by documentation?
  • Conditions correctly coded?
  • IRF-PAI accurately completed?
  • CMG & Payment Tiers appropriately assigned?

Our Risk Assessment includes

  • Exposure / Risk identification
  • Overpayments
  • Medical Necessity
  • Incorrect Coding
  • Inadequate Claim Documentation
  • Action Plan / Follow-up / Education
  • Consulting
  • Copying Services
  • Appeals Tracking Services

Diskriter's Medical Coding Compliance Assessment

  • Cost-effective
  • Maintains client privilege
  • Saves valuable time and resources
  • Corrects overpayments or improper Billing practices prior to the medical coding audit
  • Minimizes your number of denied payments in its upcoming audit
  • Reduces operational strain that such an audit can place on your staff

The Joint Commission + CARF Preparation

Diskriter can assist you with your preparation for meeting requirements in clinical coding audits as well as Medicare requirements

We can help you review your policies and procedures and conduct audits of medical records to help ensure that all medical coding compliance criteria are properly adhered to.

We approach all levels of work with a complete commitment to quality and service excellence.