Audits

Coding and Reimbursement have become increasingly difficult to manage in today’s complex and highly regulated environment. In fact, auditing obligations likely hold a notable place in any organization’s compliance plan. MiraMed On Call’s (MMOC) auditing experience with hospitals and health systems shows that our comprehensive audit approach identifies risk areas, generates performance improvements and maintains revenue integrity.

As your audit partner, MMOC provides customized audits that fit your department or facility’s needs at an affordable cost.  MiraMed On Call has long been a leader in Recovery Audit Contractor (RAC) audits. MMOC offers a comprehensive audit approach designed to ensure that payments made to client healthcare providers are accurate and proper.

What are RAC Audits?

The RAC program was created through the Medicare Modernization Act of 2003 to identify and recover improper Medicare payments to healthcare providers under fee-for-service Medicare plans. The burden of compliance is the provider’s responsibility. MMOC works with providers to ensure payment accuracy, integrity and consistency.

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MiraMed On Call’s Expertise

Coding and reimbursement have become increasingly difficult to manage in a complex and highly regulated environment. MMOC’s comprehensive audit approach, honed through extensive experience with hospitals and health systems, generates performance improvements, enhances revenue integrity, improves coding quality and provides clinical documentation improvement (CDI) educational opportunities.

As an audit partner, MMOC provides customized audits that fit department, facility or health system needs at an affordable cost.

MMOC’s RAC audit services target all RAC focus areas for the audit period, with specific attention to documentation quality, physician educational opportunities, potential query opportunities, compliance with coding guidelines and all official coding references.  MMOC requests bills for all accounts reviewed to validate that all data elements transfer correctly to the bill from the health information and billing systems. This process ensures data integrity within all information systems.

Knowing that HIM directors, quality management and compliance are focused on coding quality and education, MMOC reviews all requested data points and all RAC-specific data elements to satisfy client’s auditing needs. This can also help meet other auditing requirements that the health system or facility may have.

All staff are experienced, AHIMA/AAPC credentialed, tested and U.S.-based. MMOC ensures that staff is up to date on all coding guidelines and regulations. MMOC provides short-term, long-term, onsite or remote assistance for all enterprise audit needs. Billing can be done per chart, hourly or per project for simple pricing and MMOC will work with clients to determine the appropriate volume of accounts to audit based on the individual project scope.

Regular audits can help to:

  • Identify coding errors
  • Identify coding educational opportunities
  • Identify possible billing system or work flow issues between registration, coding, charging, billing and bill editing/claims processing software
  • Satisfy facilities’ quality or compliance reporting requirements
  • Ensure appropriate and accurate reimbursement
  • Provide insight into system-wide opportunities for improvement

Contact us today at (877) 641-9913 or email us for a free personalized assessment of your auditing needs.