Vee Healthtek provides various services, including coding, auditing, and RAC (Recovery Audit Contractor) review, for a major health system with multiple hospitals located across its state, The recovery audit program is an audit program to identify improper Medicare payments, including overpayments and underpayments as a result of coding issues. All the hospitals in this health system send the audit recommendations they receive from RAC to Vee Healthtek coders to validate the audit findings.
These hospitals were struggling to keep the DNFB down and were facing a shortage of in-house resources. Workforce constraints at the hospitals were also leading to higher costs. Two of the hospitals in this health system had coding quality issues for in-house coders and requested Vee Healthtek auditors to perform coding audits for both inpatient and outpatient facilities. The hospital group was also receiving an increased number of first appeal coding denials from RAC.
We were able to staff coders from our university-based coding school, most of whom are certified from AHIMA or AAPC, who are cross trained to work on multiple specialties, including inpatient and outpatient chart types. Our quality team reviewed the charts coded by the client coders and gave feedback by sharing our audit recommendations. These recommendations enabled the client to improve coder accuracy and quality.
The Vee Healthtek team also reviewed assigned medical records and were successful in identifying documentation and clinical indicators which supported the coding. This helped the hospitals to request second level appeals and discuss the claim with the Recovery Audit Contractor.
