Our focus
We focus on the following points in our Clinical and Regulatory Review presentation on specific diseases
Current regulations,
Cases and documentation with ICD 10 education in discussions
Audit improvement strategies
Process review and development
Education of staff on appropriate use of screening criteria
Organizational process for reviewing and referring for PA review
Medical Staff education on medical necessity of admission
Our determination letters include
- Case Summary: Includes chief complaint and summary of clinical events detailing medical necessity and severity of illness
- Bedding status recommendation: Inpatient or Observation
- Audit Risk Score: Calculated using proprietary Aerolib Analytics, this gives an estimate of the risk of an audit
- At Risk Reimbursement: based on DRG, LOS and billing submissions from existing hospital data and Medicare payments for region
- Interventions to decrease Audit Risk Score
