CASE STUDY:

Coding Performance Oversight – Primary Care

OVERVIEW
EXECUTION
RESULTS
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Coding Performance Oversight – Primary Care​- Overview

Our Client consists of one high volume practice with four specialties. The Client is an active participant in government/commercial payer initiatives to deliver value-based care. They had not implemented a robust coding and clinical documentation program and recognized this as a key strategic area for performance improvement.

SCALE was engaged to build and manage the practice’s coding and clinical documentation ongoing monitoring, provider training, and education program.

Clinical Specialties

Clinical Services

Client Profile

  • Size:
    40 Providers
  • Location:
    Dallas/Ft. Worth, TX
  • Specialty:
    Primary Care
    Nephrology
    Transplant Medicine
    Cardiology
    GI

Services Deployed

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MSO & Practice Integration

Post-Audit EducationService Title

Revenue Cycle Management

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Execution

  • Together with with Scale RCM, we collaborate with our Client to determine the audit focus each quarter, i.e. particular types of claims or payer practice.
  • We audit each provider in the practice once a quarter.
  • We provided additional remediation for providers that fell below a certain performance threshold.
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Results

  • SCALE provided strategies to assist our Client in providing clearer documentation & decrease confusion about DX addressed on each DOS.
  • We captured services that require specific documentation elements to be billable and mitigated the risk associated with documentation deficiencies.
  • We implemented a recurring, ongoing program for monitoring and improving performan
  • Through our assessments, we provided ongoing training and education to all providers in the practice to facilitate best practice in coding documentation.
  • Across the provider team we identified a subset of providers with lower scores/room for improvement, and implemented/augmented reviews, training, and education for the subset.
At re-audit, increased score due to incorrect documentation for audio-only telehealth. After implementing recommendations, achieved 100% score. Improved 23% then 37% over past quarter.

Let's SCALE together

SCALE Healthcare is based on the foundation of a singular focus – elevating management performance across healthcare services. We are focused on the entire suite of operational advisory and diligence services exclusively to healthcare service organizations, with local team presence across 10 states.

Unlike the many consulting firms that offer more narrow and often more impractical solutions borne of limited or very general expertise, we rely on our team of 75+ carefully selected senior operational healthcare experts to ensure we provide the most relevant and value added experience across the full range of management disciplines and clinical specialties that fall within healthcare services.

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