Inpatient Coding Review by Senior Consultant

Process

Such compliance reviews are performed by a St. Clair Senior Consultant, on-site or off-site via client’s electronic medical record system. For an appropriate sample of inpatient cases, St. Clair validates the inpatient coding/MS-DRG, assess the quality of supporting documentation and checks the accuracy of the Present on Admission indicator & Discharge Disposition code. For each recommended coding/MS-DRG change, St. Clair provides written justification, including references from Coding Clinic and citations from supporting documents in the patient medical record. St. Clair identifies those cases, in which we recommend a query to the attending physician to address incomplete or contradictory clinical documentation .

In the course of performing the review, St. Clair drafts a “case by case” Excel spreadsheet regarding its findings and a draft narrative report which are forwarded for client review prior to an exit conference on-site or off-site via telephone.  After obtaining a client sign-off as to resolution of all hospital questions regarding the review findings and recommendations, St. Clair issues the final report.

Benefits

Risk areas, identified by the RAC/MAC claim denials are checked for coding/billing compliance.

Pricing Approach

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