MediRevv Logo
We’re hiring!
Contact us

MediRevv Expands Scope of Services for UnityPoint Health Through Coding Audits For Compliance & Education

UnityPoint Health is one of the nation’s most integrated health systems. Their physician-led team of professionals communicates clearly and effectively to address a patient’s health care in the most appropriate setting: whether that is a clinic, a hospital, or at home. Through relationships with more than 315 physician clinics, 40 hospitals in metropolitan and rural communities, and home care services throughout its 9 regions, UnityPoint Health provides care throughout Iowa, western Illinois, and southern Wisconsin. UnityPoint Health entities employ more than 30,000 employees, working toward innovative advancements to deliver the Best Outcome for Every Patient Every Time. With projected annual revenues of $3.7 billion, UnityPoint Health is the nation’s 13th largest nonprofit health system and the fourth largest nondenominational health system in America.

UnityPoint-Health-lg
partnership

Why the Partnership?

UnityPoint Health, UnityPoint Clinic, and UnityPoint at Home provide a full range of coordinated care to patients and families. We partnered with UnityPoint Health in the Eastern and Southeastern Iowa regions to perform coding audits for compliance, provider education, and pre-merger evaluations. UnityPoint is a quickly growing organization and engaged our team to assist with internal audits for compliance and education to increase their breadth and depth to audit their many physicians in a timely fashion.

The Challenge

With technological advancements in EMRs, the responsibilities for front-end medical coding have shifted over the past few years. Many providers are now selecting codes with the assistance of templates in the EMRs. The majority of the time this new process creates efficiencies, but physicians are not certified medical coders and therefore do not have the specific expertise of knowing the myriad of complex coding guidelines. We audited charts for physicians to provide education and increase first pass clean claims rates. The government takes coding accuracy and compliance seriously and monitors claims to protect public health funds.

shap1

The Solution

icon-1-8

Audit for Compliance

We audited 644 charts, covered 4 regions which included 9 specialties. Our team examined 10 charts per physician or qualified healthcare professional — that is, anyone who bills for services. Within the 10 charts, the following was confirmed:

  • Accuracy and appropriateness of the type of services provided
  • Selected level of service is supported by the provider’s documentation
  • ICD-10 code(s) selected are correct, sequentially accurate, and appropriately linked to the proper CPT codes
icon-2-9

Audit for Education

Each provider received an individual report outlining accuracy rate and detailed information of incorrectly coded records. Coding leaders were provided with a summary report of finding across the organization.

left-donut

The Results

When performed with the right intention, style, and frequency, medical coding compliance audits provide crucial feedback and direction to enhance both coding operations and revenue cycle performance.

After completing the audit and giving individual feedback to physicians and healthcare providers, along with overall feedback to leaders on the health of the coding program, we were referred to complete audits on many UnityPoint locations throughout Eastern and Southeastern Iowa. These included new potential clinics looking to be acquired by the UnityPoint umbrella. We completed pre-merger audits to establish a baseline for new clinics.

The four categories that we audited for UnityPoint included:

Evaluation & Management (E/M) Services

Evaluated for overcoding, undercoding, and wrong service type

Procedures

Evaluated for coded—not supported, supported—not coded, and wrong code

Modifiers

Evaluated for correct and incorrect modifiers used

Diagnosis

Evaluated for correct or incorrect diagnosis findings

Our Recommendations

These included providing ongoing ICD-10-CM education and performing focused ICD-10-CM audits. We also reviewed the internal compliance plan to ensure ongoing internal/external audits occur regularly (i.e. monthly, quarterly). Since this audit, we've completed several more audits for UnityPoint and referring organizations.