Payment Accuracy

Clients can leverage VRCM’s Certified Nurse Practitioners and coding resources in undertaking chart audits for Hospitals , DRG & DRG short stay audits & APC validation. Our audit program ensures our clients are controlling costs most often associated with incorrect billing and overpaid facility claims, while reducing overall facility adjudication and reimbursement expenditures.

Our Key Highlights Key Services:

  • Hospital Bill / Chart Audits: Our robust facility claims review process ensures that any overpayments are identified and validated with the facility during the exit process.
  • DRG & DRG Short Stay review: Our experts ensure a comprehensive review and recoding of medical records based upon the procedures and diagnoses billed by the provider. We ensure appropriate DRG is reimbursed by the payer.
  • APC Validation: Ambulatory Payment Classification Validation program detects inappropriately coded claims that have already received APC payments. These most frequently occur because of CCI violations, incorrect modifier usage, and lack of relevant experience and knowledge in LMRP and LCD guidelines.

Talent Pool Why VRCM:

  • In-patient coding expertise
  • Clients achieve ROI exceeding 250%
  • Errors are found in over 95% of the claims audited
  • Auditors are Nurse Practitioners with over 5 years of experience in analysis of ICD-9, CPT & HCPCs codes, applicable CMS coding guidelines &state and federal regulations related to billing and coding for services rendered in facilities.
  • Expert manual review