Inpatient Coding Review by Senior Consultant

Such compliance reviews are performed by St. Clair Senior Consultants, on-site or off-site via client’s electronic medical record system. They validate the inpatient coding/MS-DRG and assess the quality of supporting documentation for an appropriate sample of inpatient cases. St. Clair determines whether there is sufficient chart documentation to meet the "Present on Admission" criteria to justify admitting the patient. For each recommended coding/MS-DRG change, St. Clair will provide written justification, including references from Coding Clinic and citations and markings of supported documents in the patient medical record. We will identify those cases, in which we suggest contact with the attending physician to clarify the patient’s diagnoses and/or chart documentation questions. Our Senior Consultant will conduct, on-site or off-site via a conference call, an exit conference/educational in-service regarding preliminary review findings and recommendations. 

A draft of the final report on the review findings and recommendations, with supporting documentation, will be provided within two weeks after the review. Only after obtaining sign-off as to resolution of all hospital questions regarding the review findings and recommendations, will St. Clair issue the final report.

 Risk areas, identified by the CMS RAC overpayment determinations and/or  the Office of Inspector General  are checked  for coding/billing compliance clinical documentation.

   The St Clair professional fee for an inpatient coding/MS-DRG review by our Senior Consultant is competitively priced per record reviewed, plus out of pocket expenses if performed on-site.