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Hospitals and health systems must maintain accurate code assignments to optimize reimbursements, accurately reflecting quality services, regulatory and compliance liabilities. ECLAT Health Solutions offers comprehensive auditing solutions to support Healthcare Providers with medical auditing for Inpatient, Outpatient, and Professional Fee coding.

ECLAT's medical coding audits help you better understand the return on investment (ROI) and accuracy of each individual coder on your team as well as your investment in external contract coding resources. In addition to monitoring and improving the accuracy of coders, our third-party auditing solutions also help identify Clinical Documentation Improvement (CDI) opportunities resulting in decreased Physician Queries for accurate and specified code assignment.

Customizable Frequency & Sample Size

The frequency of audits can be tailored to meet the specific needs of each individual hospital or health system. Solutions can be availed per clients’ needs bi-annually, quarterly, or other desired parameters depending on the interest and goals. Support can be provided on all chart types, specific chart types, specific coders, high alert cases (RAC, OIG, etc.), or other focused areas. ECLAT can accommodate your preferred sample sizes or provide the recommended sample sizes for different charts types and/or code sets to be audited.

Specialties & Expertise

ECLAT provides expert auditing solutions focused on the following areas with the option to pick and choose individually from our many solutions:

Inpatient medical records including assignment of ICD-10-CM and ICD-10-PCS, as well as, MS-DRG and/or APR DRG assignment, Present on Admission (POA) indicators and Discharge status
Outpatient same-day surgery (ambulatory surgery) medical records including assignment of ICD-10-CM diagnosis and ICD-10-PCS (if applicable), CPT-4 procedure codes and modifiers, and HCPCS codes, wherever applicable
Observation medical records to include assignment of ICD-10-CM and ICD-10-PCS, CPT-4 codes and HCPCS codes, wherever applicable
Emergency department medical records including ICD-10-CM, CPT-4 codes and modifiers, as well as, Evaluation and Management (E&M) Levels for Professional or Facility components, injections and infusions, wherever applicable
Outpatient ancillary medical records including assignment of ICD-10-CM and CPT-4 codes wherever applicable
Physician professional services including ICD-10-CM codes, Evaluation and Management (E&M) level, CPT-4 codes and modifiers wherever applicable
Clinical documentation improvement (CDI) opportunities

ECLAT follows official coding guidelines and references (such as Coding Clinics, CPT-4 Assistant, NCCI, NCD/LCD, OCE and MCE), in addition to Customer-specific guidelines to the extent such guidelines do not contradict official resources. Payer-specific requirements are also taken into consideration.

Additional Focus Options

ECLAT can provide your practice with the following focus options, if requested:

Validation of principal diagnosis, first-listed, and/or principal procedure selection/assignment
Validation of all secondary MCC, CC, and other reportable diagnosis and/or principal procedure selection/assignment, in addition to logical sequencing regardless of impact to MS-DRG or APC calculation to ensure overall coding quality (full code review)
Validation of discharge disposition and transfer status
Operational assessment related to coding (i.e. – incomplete source documentation for accurate coding and workflow)

Also, wherever noted and/or requested, ECLAT will document discrepancies with the following:

Compliance with potential Fraud and Abuse issues per HIPAA and HITECH regulations
Compliance with Federal and State and/or other regulatory entities
Research and explanation of coding rationale related to appeals processes (e.g., Corporate Audits, RAC Audits, MIC Audits, etc.)

Audit Findings & Education

Education and training is a critically important part of any audit. Education and training are available to the following team members upon request: CEO, CFO, Controller, HIM Director, Coding Manager, Coding Supervisors, Coders, and Physicians.

Executive Summary outlining the overall scope of the audit and initial findings and results
Final Report with findings by coder as well as overall facility performance for MS-DRG/APC and overall coding accuracy; where requested: discharge disposition, patient type, and POA assignment accuracy rates
Financial impact analysis based on findings
Education session for coding staff based on opportunities identified, and/or as requested
Training on specific coding/abstracting/query logic (case by case option/assessment)
Debriefing session with desired hospital leadership team

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Experience Brilliance with ECLAT

The word “é·clat” means “Brilliance” in French, and we strive to live up to our name by crafting business partnerships that work brilliantly in a symbiotic nature. ECLAT Health Solutions offers flexible and comprehensive solutions for healthcare revenue cycle management services such as Medical Coding, HCC Coding, CDI, and Medical Billing. Contact us to begin your auditing today!

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