Hirschl & Associates provides its clients with services that improve revenue, documentation, and data quality, decrease compliance risks, develop internal human resources, and implement best practices.

Hirschl & Associates provides a specialized and niche service line that bridges the relationship between Clinical Coding and Revenue Management. By understanding the correlation between coded data accuracy (HIM, CDM, UB-92, and HCFA-1500) and revenue management, Hirschl & Associates is able to assist its clients in identifying and developing initiatives that generate financial and compliance performance improvements. Hirschl & Associates Initiative-based Revenue Management and Clinical Coding Coordination Services include:

Hospital Services

DRG and Coding Compliance Management

Focusing on Office of Inspector General (OIG), Add-on payment, Post-acute Care Transfer, One-day stay, PEPPER, and client specific DRG targets as identified by data analysis, H&A performs DRG and Coding Compliance audits that identify opportunities for risk avoidance, revenue improvement, as well as coding and clinical documentation enhancement. DRG and Coding Compliance Management services include and are not limited to:

• Data analysis,
• Account selection,
• Transactional medical record and billing review,
• Report generation, and
• Training and education.

Recovery Audit Contractor (RAC) Auditing (DRG, Inpatient Rehabilitation, Outpatient Services)

Focusing its review on those accounts that will be targeted by the federal government’s contingency-fee based RAC program, H&A conducts pro-active “Pre-emptive RAC Readiness” audits of inpatient and outpatient coding, physician documentation, charge capture, and billing practices to determine a provider’s potential vulnerability to scrutiny, compliance risk and financial recourse. RAC Services include and are not limited to:

• Data analysis,
• Account selection,
• Transactional medical record and billing review,
• Report generation
• Training and education, and
• Defense and appeals processing.

Outpatient Revenue/APC Management

By identifying target areas that offer significant opportunity for net patient revenue improvement and/or compliance risk-avoidance, H&A provides Outpatient Revenue/APC Management Services that identify trends and patterns, establish baselines, correct root-cause deficiencies, and forecast potential net revenue impact. Outpatient Revenue Services include and are not limited to:

• Data analysis,
• Account selection,
• Transactional medical record, billing, CDM, and claim form logic review,
• Action plan development and implementation,
• Report generation
• Trending, tracking, and monitoring, and
• Training and education

Using financial and clinical data analysis, H&A has provided Outpatient Revenue/APC Management in the following service areas.

• Emergency Department
• Cancer Center/Oncology Services
• Infusion Therapy
• Cardiovascular Lab/Interventional Radiology
• Radiation Therapy
• Clinics
• Pharmacy Department

Clinical Documentation Improvement

Working with Physicians, Case Managers, and Coding Professionals, H&A develops customized approaches to improve clinical documentation. Peer networking, training, and outcomes metrics are used to best meet our clients' specific needs.

Medical Necessity Monitoring

Utilizing National Coverage Determinations (NCDs) and Fiscal Intermediary (FI) Local Coverage Determinations (LCDs), and Interqual criteria H&A develops and implements best practices to manage medical necessity standard requirements and to reduce Medicare inpatient and outpatient denials.

Charge Description Master Maintenance

Using state of the art CDM management tools, H&A assists healthcare providers to build, maintain, and manage compliant and financially accurate CDMs. H&A provides the following CDM services:

• Updating and maintenance,
• Management and analysis outsourcing, and
• Training and internal staff development.

Charge Auditing

Applying client specific charge protocols and using customized software, H&A performs Charge Auditing services that address compliant charge capture practices, efficient charge entry processes, and defense auditing activities.

Education, Training, and Development

Developing customized programs, H&A educates and trains staff in the following areas.

• DRGs, Severity refined and existing model
• APCs
• ICD-9-CM and CPT-4 coding
• Internal Coder Development
• Charge Capture
• CDM Maintenance and Management
• ICD-10 and ICD-10-PCS Coding and Correlating Physician Documentation Requirements
• SNOMED Coding and Classification

Physician, Medical Group, IPA, and Health Plans Services

Risk-Adjusted Medicare Advantage HCC Management and Insourcing

Applying the new Medicare Advantage Risk-Adjusted payment methodology (HCCs), H&A assesses the accuracy of coding and documentation and their impact on Medicare Managed Care reimbursement. H&A provides on-going HCC management and Data Sweep auditing services that generate outstanding HCC revenue improvement. H&A’s HCC services include but are not limited to:

• Data analysis and data mining,
• Risk adjusted probability factor identification,
• HCC account review selection,
• Coding and physician documentation audits,
• Physician and coding staff education, and
• Best practice, forms and tools to improve HCC revenue development and implementation.