Client StoryUnityPoint Health

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About UnityPoint Health

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 280 physician clinics, 37 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.

Why the Partnership?

UnityPoint Health, UnityPoint Clinic and UnityPoint at Home provide a full range of coordinated care to patients and families. MediRevv partners with UnityPoint Health in the Eastern and Southeast Iowa regions to perform coding audits for compliance, provider education and pre-merger evaluations.

UnityPoint is a quickly growing organization and procured MediRevv to assist with internal audits for compliance and education to increase their breadth and depth and the ability 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 to follow.

MediRevv audits charts for physicians to provide education and increase first pass cleans claims rates.  And, just to be clear, the government takes coding accuracy and compliance seriously and monitors claims to protect public health funds.

The Solution

Audit for Compliance

MediRevv audited 644 charts, covered 4 regions which included 9 specialties. MediRevv also examined 10 charts per physician or qualified healthcare professional—that is, anyone who bills for services.

Within the 10 charts, the following was confirmed:

  1. Accuracy and appropriateness of the type of services provided
  2. Selected level of service is supported by the provider’s documentation
  3. ICD-10 code(s) selected are correct, sequentially accurate and appropriately linked to the proper CPT codes
  4. Modifiers are attached and appropriate, when necessary
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.

Testimonial What Our Client Said

Nita Wilson

Director of Coding
I have had the pleasure of working with MediRevv for the past one and a half years in a variety of projects. MediRevv has been a very knowledgeable, accommodating company to work with.

Their coders have a vast array of knowledge and experience in many different specialties and have been able to step in and assist Unity Point with complex auditing and coding reviews. They are timely and thorough and have been able to provide in-depth reports and analysis."

The four categories of results that MediRevv audited for UnityPoint included:

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E/M Services
Evaluated for overcoding, undercoding, and wrong
service type.
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Evaluated for coded—not supported, supported—not coded, and wrong code.
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Evaluated for correct
and incorrect modifiers used.
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Evaluated for correct or incorrect diagnosis findings.

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, MediRevv was referred to complete audits on many UnityPoint locations throughout Eastern and Southeast Iowa. These included new potential clinics looking to be acquired by the UnityPoint umbrella — MediRevv completes pre-merger audits to establish a baseline for new clinics. 

Our recommendations for UnityPoint Clinic included providing ongoing ICD-10-CM education and performing focused ICD-10-CM audits. Also, we review the internal compliance plan to ensure ongoing internal/external audits occur at regular frequency intervals (i.e. monthly, quarterly.)  Since this audit was completed in April of 2018, MediRevv has completed several more audits for UnityPoint and referring organizations because of the  trust and value we have with UnityPoint Health.

The Highlights

HCC “Next Steps” for Your Organization

Value-based care is about treating patients with a whole health approach, and to get the full picture, providers need to document completely and accurately so that coders can select ICD-10 codes to the highest level of specificity as well as attach HCC codes. But these steps – which sound simple – requires attention to your process and workflows.

Awareness of HCC is imperative across your entire organization. Every stakeholder must understand the value-based “why” behind HCC, which makes education imperative. Make sure your physicians understand not only how, but why to document with specificity.

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