Records Management Solutions
Pergroup’s processing teams’ knowledge of correct coding and data entry encompasses all types of medical encounters. We understand the entire revenue cycle from the time the patient steps in the door until the claim has been finalized.
Our experience and time-tested track record reveals that our effectiveness and successful partnerships with clients are crafted on five proven pillars of delivery.
Effective communication is no more critical than at the onset of our collaboration. From the moment the contract is executed, time is of the essence to achieve on time the desired results. The time it takes to implement remote connectivity, employee access to the EHR and RPMS systems can dramatically delay or paralyze a project’s completion. We start with a project initiation meeting in which the technical protocols and processes are discussed and agreed upon.
We then prepare a protocol for each service unit that orders our services. This living document is adjusted and revisited throughout our relationship with the service unit. A single, central point of contact is another key facet of our effective communication. All questions and interactions from within the fulfillment team are channeled through a single point of contact. Through this approach, facility personnel are assured that Pergroup is focused on the task at hand, just as they are.
Batch testing is our second pillar, which begins after the protocol and process review. We perform low-volume processing of a sample batch of items. In this sample of 500 items or less, we thoroughly audit and examine the items against the agreed-upon protocol approved by the facility. At this stage, each facility’s personnel also will review results to ensure they meet their expectations, highlighting once again our pillar of effective communication. Following this testing, we again revisit and adjust the protocol to match any go-live changes that materialize. Only upon full completion and acceptance of batch testing does full production begin. We hold the success of this batch testing in high regard as it is the benchmark for your continued revenue generation in years to come.
Continuous dialogue throughout the contract period ensures successful delivery of results. Communication will be ongoing and weekly conference calls will be held to provide project updates and address any issues or problems that may arise.
Checks and balances are conducted in the form of thorough quality assurance reviews of each step of the process, including evaluation of the inventory workflow and control.
Delivery Timeframes and Volume Capacity will be provided and fulfilled to each Service Unit as ordered. We have the capacity and resources to meet the vast majority of our client’s estimated quantities and are able to adapt and stay within internal control standards in the event that quantities are more than anticipated. Our coding team currently processes a minimum of 100 outpatient items per day and 12 inpatient encounters per day. This does vary based on the clinic and the complexity of the visit as well as length of stay for an inpatient encounter.
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.
Ensuring the integrity of the patients legal health records
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.