Records Management Solutions

Our experience and time-tested track record reveals that our effectiveness and successful partnerships with clients are crafted on five proven pillars of delivery.

Pergroup adheres to the following standards for workloads assigned to us:

• We adhere to all Internal Control/ORAP Policy Guidelines of being within four days from date of service for ambulatory encounters once coding backlogs are resolved. In the event of a lag in work assignment to Pergroup, we are committed to our part of the process and assure that all visits are coded in a timely manner. In the event of a coding backlog, the oldest dates of service are processed first and within an agreed upon timeframe with the Service Unit.
• Proper and necessary ICD diagnosis and procedure codes, CPT, HCPCS, DSM, CDT and E/M codes and appropriate modifiers are assigned based on documentation, coding guidelines, Centers for Medicare and Medicaid Services (CMS) guidelines and specific payer guidelines.
• Thorough and complete understanding of Meaningful Use and the importance for both the facility and in the quality of care provided to the patient. In addition, we are well-versed and knowledgeable in the use of SnoMed and the Integrated Problem List.
• Coding and abstracting of all ambulatory (outpatient) encounters to include Home Care, Nursing Home and School-Based visits that are assigned to us based on documentation available on paper and electronically; such documentation to include:
  • History and Physical (H&P)
  • Assessment and Plan
  • Diagnostic and Therapeutic orders
  • Diagnostic and therapeutic procedure report
  • Outpatient documentation requirements
  • ER/ED documentation requirements
  • Electronic Health Record (EHR)
  • SnoMed and Integrated Problem List (IPL)
• Signature requirements
• Nursing documentation requirements
• All information from Electronic Health Record (EHR) and Vista Imaging is entered into the Resource and Patient Management System (RPMS) to ensure that all services provided are captured and all Government Performance Results Act (GPRA) data and health factors are captured. All relevant information from the Electronic Health Record (EHR), PCC, IPL, etc. is reviewed and captured for health data statistics, reimbursement and patient care purposes. We ensure the final diagnosis stated by the provider is valid, complete and accurately reflects the care and treatment provided.
• Assignment of applicable coding conventions to include ICD-9-CM, ICD-10-CM, CPT, HCPCS Level II, DSM and CDT based on provider documentation. E&M levels are assigned using the correct CPT code, Local Coverage Determination and applicable modifiers. Codes are also received for CCI edits. Any items/ancillary services on the coding queue that are related to a visit are reviewed and merged to the primary visit when appropriate. Any ancillary service that is deemed to be a stand-alone visit after complete review is processed accordingly. Any merge action is verified for completeness and the Service Units are not charged for merges.
• Visits that are left in an incomplete status due to further documentation needed, missing provider signature, etc. are left with a chart audit note stating the reason for the incomplete status. A notification is sent to the appropriate person either electronically through EHR or sent via another process as determined by client and Pergroup. Incomplete visits are reviewed regularly, if missing information is not provided in an agreed upon timeframe, the visit is escalated to the next tier for resolution. Once missing information is provided, the visit is completed, at which time Pergroup charges for the visit. We will provide a running record of incomplete visits and complete the visit promptly as the deficiency is addressed.
• We process only those items that are assigned to us by reviewing the coding queue on a daily basis. Our objective is to process everything on the coding queue for the dates of service and clinics we are assigned.

Our staff has extensive working knowledge of the various RPMS applications that feed data to the PCC package, including but not limited to EHR, ADT and the Behavioral Health package. Pergroup’s processing team utilizes all aspects of the patient’s EHR, in conjunction with the paper record, as legitimate forms of documentation of all patient care activities.

Our staff is knowledgeable on how and where to find all of the documentation within EHR that is needed to completely and accurately process encounters. By utilizing all aspects of EHR for documentation verification, Pergroup staff ensures the integrity of the patient’s legal health record remains intact.

Pergroup teams’ knowledge of the mnemonics used in the processing of medical encounters is second to none. We make every effort to stay informed of any additions and/or changes that occur with the mnemonics utilized in the RPMS PCC Data Entry module. This includes the use of the CPE mnemonic when capturing the services identified with a CPT or HCPCS code. We understand that using the CPE mnemonic for the coding of services enables the capture of all factors affecting the service, including:

• Any modifier(s) needed to completely describe the service provided
• The diagnosis associated with the service that provides medical necessity for the service
• The date and time the service was provided
• Provider of the service

Our standard practice is to provide progress reports to the Service Unit as part of our service and as supporting documentation for our invoices. Items will include but not be limited to:

• Data tracking log to ensure that all Coding Queue items are accounted for
• Status update of coding queue items
• Number of visits in incomplete status and incomplete reasons
• Number of items merged
• Number of visits completed

Each Pergroup healthcare services team member holds a minimum of a CPC credential through American Academy of Professional Coders (AAPC), with several holding multiple credentials through both APPC and American Health Information Management Association (AHIMA) and multiple third-party billing certificates. Typically, our team devoted to you has more than twenty years of experience in coding, data entry, third party billing, electronic claims submission and accounts receivable services.

All coding staff within Pergroup are held to an accuracy level of 98%. Our auditing does not consist of only verifying the accuracy of the ICD, CPT and HCPCS coding, we also verify that all documented Health Factors, Patient Education, Exams, and GPRA/CRS measures are properly and completely captured.

Pergroup maintains strict confidentiality of all matters, adhering to the Privacy Act and HIPAA Privacy Rules in each encounter. We perform random sample audits of a minimum of 10% of visits processed on a semi-monthly basis. Pergroup follows the Office of Inspector General (OIG) Compliance Program Guidance for Hospitals and has a complete coding, third party billing and accounts receivable compliance plan that is available upon request.