Solution Showcase: Boost Compliance. Elevate Accuracy

Solution: Provider Support

Topic:  Boost Compliance.  Elevate Accuracy: Enhancing Provider Documentation and Charge Capture.

Organization: Start-up Healthcare Organization

Services Overview:  A start-up healthcare organization engaged J2 Integrity Solutions LLC to evaluate provider documentation and provider charge capture accuracy by providing virtual at-the-elbow support to ensure compliance and revenue optimization.

Challenges & Solutions:

1. Accurate Capture of Provider Work:
   • Issue: Over 50% of accounts were upcoded, posing compliance risks.
   • Solution: Delivered educational sessions on CMS coding standards. As a result, providers improved their code selection accuracy by over 40%, reducing the risk of upcoding and payer audits.
     
2. Documentation Process Optimization:
   • Issue: Inefficient documentation and limited EMR functionality.
   • Solution: Collaborated with the EMR vendor to optimize system capabilities. Developed seven smart phrases for different coding scenarios, including medical decision-making levels, billing options, and telehealth requirements, streamlining provider workflows.
     
3. Ongoing Monitoring:
   • Issue: Compliance needed continuous monitoring to ensure lasting improvements.
   • Solution: Conducted spot checks, identifying an outlier provider who required additional training. Tailored education resolved the compliance issues.

1. Ad Hoc Consult Services:
   • Issue: Ongoing coding and documentation challenges.
   • Solution: Provided continuous support through ad hoc consultations, ensuring timely guidance and expert resolution of emerging issues.

Results:

• 40% improvement in coding accuracy.
• Enhanced documentation processes with optimized EMR functionality.
• Sustained compliance through ongoing monitoring and individualized education.
• On-demand expert support for continuous improvement.

Conclusion: J2 Integrity Solutions’ comprehensive provider support improved the client’s coding accuracy, documentation processes, and compliance, equipping them to maintain operational efficiency and accuracy in their billing practices.