Utilization Reviews give you a faster, better way to help validate that patient admissions to your hospital meet clinical criteria. Our team of expert nurse reviewers consistently screen admissions for medical necessity and identify cases for second-level evaluation by physicians. Because our licensed nurse reviewers handle admission reviews accurately and efficiently, your local case managers have more time for direct patient interaction and care planning.
Periodic and consistent charge description master (CDM) audits can be critical to improving the quality and integrity of your billing functions. Through ourTCG’s Charge Integrity service, we may review your claims before or after payment depending on your needs. Our process is flexible and can be customized whether your facility has an electronic medical records system, a hybrid record, or a paper record.
TCG’s subject matter experts analyze your CDM and your specific charge capture methodologies through reviews of clinical documentation (such as physician orders) and billed charges, as well as interviews with department staff. We integrate our onsite reviews with our data analysis. Our comprehensive reports and recommendations can help you identify opportunities to improve the accuracy of your charges and educate your staff.
Coding Services for Hospitals and Health Systems delivers a comprehensive suite of coding and patient financial services, ranging from coding audit outsourcing and planning, to specific chart audits and RAC readiness assessments. We offer inpatient, outpatient and professional fee coding services for every major specialty, including those with complex coding requirements such as radiology and anesthesiology. We can customize our solutions to meet your business needs; from operational assessments and consulting, to management staffing and support, to full outsourcing of your coding functions.
Clinical documentation is at the core of every patient encounter, and supports the reporting needed to measure clinical quality and secure accurate and appropriate reimbursement. A robust Clinical Documentation Improvement (CDI) program may be essential to your preparedness for the ICD-10 transition. TCG Clinical Documentation Improvement for Hospitals and Health Systems helps to ensure that clinical documentation is accurate, timely, and clearly reflects the scope of services provided. Our HIM professionals provide ongoing education and improvement initiatives to help your CDI programs support complete and accurate reporting to your stakeholders. After the ICD-10 transition, continuous education and monitoring will remain critical as the industry and payers continue to adjust and develop new methods to incentivize higher quality patient care.