Services Deployed
MSO & Practice Integration
Post-Audit EducationService Title
Revenue Cycle Management
Overview
Our Client consists of one high volume practice with four specialties. The Client is an active participant in government/commercial payer initiatives to deliver value-based care. They had not implemented a robust coding and clinical documentation program and recognized this as a key strategic area for performance improvement.
SCALE was engaged to build and manage the practice’s coding and clinical documentation ongoing monitoring, provider training, and education program.
Execution
- Together with with Scale RCM, we collaborate with our Client to determine the audit focus each quarter, i.e. particular types of claims or payer practice.
- We audit each provider in the practice once a quarter.
- We provided additional remediation for providers that fell below a certain performance threshold.
Results
- SCALE provided strategies to assist our Client in providing clearer documentation & decrease confusion about DX addressed on each DOS.
- We captured services that require specific documentation elements to be billable and mitigated the risk associated with documentation deficiencies.
- We implemented a recurring, ongoing program for monitoring and improving performan
- Through our assessments, we provided ongoing training and education to all providers in the practice to facilitate best practice in coding documentation.
- Across the provider team we identified a subset of providers with lower scores/room for improvement, and implemented/augmented reviews, training, and education for the subset.
Acquisition Strategy was Flawed; Poor Integration, Lack of Management have Exacerbated Issues