Charge Capture, Compliance, Medical Necessity Admission and RAC Reviews

MP900438630Hospital payments are increasingly coming under close scrutiny by CMS, OIG, OMIG and other payers, not to mention the RACs (Recovery Audit Contractors). It makes good business sense to know your areas of risk and address them before the payers do it for you. With our compliance consulting services we will work with you to screen your billing data, manage your denials, identify risk areas, and develop strategies to assess and correct these issues.

We can review your short stays against InterQual or other admission criteria and assess your vulnerability. When appropriate, we will work with your legal counsel to self-disclose. Epoch has worked with many hospitals and understand the areas of RAC focus. In many cases this may necessitate tightening your utilization management, or implementing a documentation improvement program. Whatever approach is needed, Epoch is here to assist you!

An integral part of compliant billing is accurate and complete charge capture. Hospitals need to assess their processes, systems and data to ensure that all services performed, and only services performed, are documented, accurately entered in the applicable feeder system and captured in the hospital’s billing system. Every year, hospitals lose reimbursement when services performed slip through the system without being charged – something hospitals can’t afford. We will work with your hospital to identify lost charges, isolate the areas of risk and develop strategies to address the issues.