Clinical Revenue Integrity

Clinical Revenue Integrity

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Appointment Management

The Chappelle Group

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.

Key Benefits

The Chappelle Group
• Improve your ability to capture patient appointments across points of care
• Extend scheduling hours to capture additional appointments and cancellations
• Provide reminders to reduce no-shows for scheduled appointments
• Improve overall patient and physician satisfaction
• Better support test and treatment coordination with multiple providers

Charge Integrity Services

The Chappelle Group

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.

Key Benefits

The Chappelle Group
• Identify gaps in Charge Description Master (CDM)
• Reduce bill holds, claim rejections and denials
• Improve the charge capture and CDM management processes
• Resolve charging questions and issues with access to subject matter experts

Coding Services

The Chappelle Group

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.

Key Benefits

The Chappelle Group
• Pinpoint areas of risk and potential coding issues
• Improve efficiency of the revenue cycle
• Identify opportunities for tailored training for physicians and coders
• Prepare for Recovery Audit Contractor (RAC) and other government program audits

Clinical Documentation Improvement

The Chappelle Group

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.

Key Benefits

The Chappelle Group
• Enhance clinical documentation specificity to support accurate code assignment
• Identify potential compliance issues and areas for improvement
• Provide tailored CDI training to your physicians
• Educate your physicians on heightened documentation expectations due to regulatory mandates

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