Total Chart Review
Our Clinical staff provide a comprehensive review of the entire patients charts from SOC to RECERT and Discharge.
♦ Provide a comprehensive review of the entire patient's chart from SOC to RECERT and Discharge.
♦ Monitor Compliance with Medicare documentation based on CMS' Conditions of Participation.
♦ Ensure patient care is accurately reflected in clinicians' documentation and quality care is reflected in the outcomes.
Our Clinical staff performs a review of the full chart and the 60-day summary of the episode requested.
♦ Perform review of full chart and 60-Day Summary of the episode requested.
♦ Compare Physicians Orders, Face to Face, and other important documents to show consistency with each other as well as the plan of care.
♦ Suggestions and recommendations will be provided for each deficiency identified based on Condition of Participation and Medicare clinical guidelines.
Are you a Medicare Home Health Provider in IL, TX, FL, OH, or NC?
We have the knowledge and experience from receiving 100% affirmation during the Illinois Pre-Claim Review period!
Take advantage of our Home Health Review Choice Demonstration (RCD) Services. We ensure that documentation for your home health services are appropriate for payment based on your choice.
- ♦ Pre-Claim Review
- ♦ Post-Payment Review
- ♦ Minimal Post-Payment Review
“When performing medical review as part of Targeted Probe and Educate (TPE), Medicare Administrative Contractors (MACs) focus on specific agencies that bill a particular item or service rather than all agencies billing a particular item or service. MACs will focus only on agencies who have the highest claim denial rates or who have billing practices that vary significantly from their peers. TPE involves the review of 20-40 claims per agencies. This is considered a round, and the home health provider has a total of up to three rounds for reviews. After each round, agencies are offered individualized education based on the results of their reviews. Home health agencies are also offered individualized education during a round to more efficiently fix simple problems.” – Center for Medicare/Medicaid Services
- ♦ HealthCare Synergy will review the letter from the MAC auditor that requests the 20-40 claims reviewed during that round.
- ♦ Our clinicians will research and review supporting documentation within the affected charts, documenting deficiencies and billing errors.
- ♦ We provide appropriate corrections to address deficiencies and errors, using our proprietary process in checking against Medicare Conditions of Participation.
- ♦ Our complimentary Chart Review assists agencies in determining their risks for future Targeted Probe and Educate – we offer consultation and training to agency staff to help avoid future claim denials.
Is your agencies QAPI program survey ready?
The new 2018 Home Health Conditions of Participation require your agency have an agency-wide, data-driven quality assurance, performance improvement (QAPI) program that effectively identifies areas for improvement in quality care and patient safety. Healthcare Synergy’s experts will partner with you to develop or strengthen your QAPI program via fact-finding interviews, analyses of your current QAPI practices, and review of outcome results. Your agency will receive a proactive QAPI model that reflects your strategic priorities and the requirements set in the Conditions of Participation for Home Health and or Hospice Agencies.
Specific results of the Healthcare Synergy QAPI Program Consultation include:
♦ Develop an individualized QAPI Program policy and procedure.
♦ Identify the possible data elements, data collection activities and analysis schedule.
♦ Ensure the QAPI project/s reflects the Agency’s services and operations.
♦ Establish the role and have clarity on the responsibilities of the agency’s leadership and governing body related to the QAPI program.