Our retainer clients receive valuable auditing of records as part of our core retainer services. Besides our trainings and data analytics designed to help organizations be complete and accurate in their documentation and coding, our RN coders review selected internal medical records (3-5% of active Medicare members per month) to validate that submitted diagnoses for Risk Adjustment purposes are supported by documentation and also that the documented diagnoses are all submitted. This bi-directional audit is valued for validating compliance with the additional benefits of being available for integration into an organizations QAPI program as well as supplying evidence for internal auditing and monitoring processes to support Part D requirements.
Our nurse coders provide a rationale and suggested action for each diagnosis outcome and provide both summary and detail reports. Detail reports are supplied in Excel workbook format with multiple tabs and color-coding to allow for tracking and trending. The audit results provide rich sources for QAPI and for feedback to providers to support documentation improvement efforts.