The accuracy and quality of your medical records coding is critical to the financial and compliance health of your organization. Ensuring adherence to coding guidelines, best practices, and legal and contractual obligations is the cornerstone to ensuring you get paid for your services.

RevenueMed’s RevAudit team provides unbiased reviews of coding performance by analyzing chart data, principal diagnosis, relevant documentation, assigned ICD-9 codes and demographic data. We frequently spot opportunities where facilities are missing considerable revenue; we can deliver permanent solutions to ensure top revenue performance.

Our audit process includes three phases:

Phase 1 – Pre-Audit:

RevAudit consultants will meet in person or via web conference to determine the scope of the audit (high volume, high frequency, or high complexity areas), sampling sizes, and types of sampling. In the Pre-Audit stage we will also address logistical details such as audit dates, audit location, method of chart access, and any information systems considerations.

Phase 2 – Audit :

Our experienced, credentialed coding experts will start by studying the coding policies and guidelines in force at your facility, to ensure that the audit uses your hospital-specific criteria.

We will load your coders’ original codes into our proprietary RevAudit software tool and then re-code the charts, including appropriate abstracting. After re-coding, we will a group these codes into the DRG appropriate for your facility.

After re-coding and re-abstracting, we will provide comparative analysis of codes, administrative data and DRGs, including revenue ramifications. Because of the considerable impact that clinical documentation has on coding thoroughness we will also point out instances where documentation can be improved.

Phase 3 – Present Findings and Recommendations:

In the final phase, RevenueMed will prepare and distribute an audit report, which will detail all relevant findings from the audit. This will include a detailed comparison of all diagnoses, DRGs and abstracting elements. Where we can identify possible sources of mis-coding, we will make specific recommendations to improve areas like system problems, imprecise guidelines or clinical under-documentation.

The RevAudit System:

RevenueMed has invested heavily to create a best-of-breed software solution to manage our audit engagements. Our RevAudit software allows us to efficiently compare “before and after” codes, while also cataloguing wider observations for additional reporting. This tool allows us to deliver our audits more thoroughly and more efficiently than less sophisticated auditors. And for those clients that seek routine auditing assistance, RevAudit provides helpful trending statistics.

Audit Location:

RevAudit personnel can be deployed at your location, which some clients prefer because it affords significant direct interaction. We can also administer audits remotely. For those hospitals that have an internal Electronic Health Record, we can access records via secure VPN. For those whose records are partially or fully in paper form, we can even provide the scanners and workflow software for charts to be digitized and securely routed to our auditors for remote access. Remote options save considerable cost by reducing travel expense.

In order to meet your organization's specific needs, our coding audits can be offered as a onetime engagement, or on a quarterly, semi-annual, or an annual basis.