REVIEWMATE: THE QUINTESSENTIAL AUDITING PLATFORM

IPPS

The IPPS (Facility Inpatient) auditing module is part of ReviewMate auditing suite and provides:

• Accuracy rates for all elements including: MS-DRG, APR-DRG, SOI, ROM, Diagnosis, Principal Diagnosis, Secondary Diagnosis, POA, Discharge Disposition, Procedure (PCS), CPT/HCPCS (optional), Procedure Provider, Procedure date, MCC, CC, HCC and HAC.

• Both MS-DRG and APR-DRG pricing and grouping

• ICD-10-CM, ICD-10-PCS, ICD-9-CM and CPT/HCPCS code sets

• Support for Pro Fee audit within the IPPS module

• Identification on the screen of codes with MCC/CC/HAC/HCC value

OPPS

The OPPS (Facility Outpatient) auditing module is part of ReviewMate auditing suite and provides:

• Accuracy rates for all elements, including APC, CPT/HCPCS, E&M, non-E&M, Modifier, Revenue Code, Service Units, Diagnosis, Discharge Disposition (optional), Procedure Provider, Procedure Date, and HCC

• APC and fee schedule pricing and grouping

• ICD-10-CM, ICD-10-PCS (optional) and CPT/HCPCS procedure code sets

• Accuracy rates by Patient Type (observation, ED, Clinic, etc)

• Ability to assign responsibility on the line-item level to obtain individualized accuracy rates for the

different contributors to the UB-04 (coder, charge team, radiology, etc)

• Support for Pro Fee audit within the OPPS module

• Identification of line items that were recalculated because of another line item revision

ASC

The ASC (Ambulatory Surgery Center) auditing module is part of ReviewMate auditing suite and provides:

• Accuracy rates for all elements, including APC, CPT/HCPCS, E&M, non-E&M, Modifier, Service Units, Diagnosis, Procedure Provider, Procedure Date, and HCC

• APC and fee schedule pricing and grouping

• ICD-10-CM, ICD-10-PCS (optional) and CPT/HCPCS procedure code sets

IPPS, OPPS, PROFEE, ASC modules of ReviewMate include Code Lookup, Full suite of references including Coding Clinic, CPT Assistant, Clinotes, Principal Diagnosis Analysis, DRG Analysis, and the AHA Coding Handbook and Accuracy Rates.

CMS-HCC

The CMS-HCC (Risk Adjustment) auditing module is part of ReviewMate auditing suite and provides:

• The ability to parse large amounts of HL7 data to “weed out” visits that do not qualify for CMS-HCC reporting

• After uploading coded data, auditing can be accomplished in any of three ways:

o Reviewers can audit each patients’ diagnosis codes on an encounter-by-encounter in a granular fashion.

o Reviewers can access a listing of each patient’s missing HCCs and add them, if appropriate. o A listing of the diagnosis and HCCs missing from year to year, by patient, can be provided to

interested parties to make decisions such as, where to concentrate auditing efforts and what patients need to be seen in the current year.

WORKFLOW ANALYTICS

Workflow Analytics is a module that helps managers understand the details of their audits and measure the productivity of their staff. It highlights any bottlenecks that may increase project duration and increase auditing costs. This module displays detailed metrics from the beginning of an audit until the reporting is finalized.

It will show staff productivity on a monthly, daily, and yearly bases for both reviewers and coders. The system can display and report turnaround times of patient accounts and audits so the user can understand their workflow pattern and forecast future projects.

It creates metrics for:

• Findings per Audit Type per Reviewer

• Communication and collaboration time

• Number of diagnosis, procedure and CPT/HCPCS codes reviewed

• Number of assigned records vs. number of completed records

• Timeline of every single event taking place from creation of an audit to completion

• Compare productivity between two auditors taking in consideration many aspects of audit complexity.

HCC Analyzer

• CMS-HCC Analyzer can parse data from EDI billing files automatically and convert to an Excel spreadsheet. It can analyze up to 10 million claims in one day and generate an analysis that can help auditors/managers concentrate auditing efforts on the most at-risk patients. It also identifies missing encounters for the current year to assist in identifying patients that need to be seen by a provider.

• CMS-HCC analyzer can be used for facilities, physician offices and any care provider facility that deals with HCC risk adjustment.

• HCC Analyzer will integrate seemingly with ReviewMate HCC Auditing Module in which you can convert potential HCC issues to an actual deep dive audit managed by an HCC auditor.

SAMPLE SELECTOR AND RANDOMIZER

Integration Manager can automate audit creation and eliminates the manual process of importing data into ReviewMate from spreadsheets. Data can be mined with a preset library of rules, or rules can be created by the client. Flags in the data set can be used to pull accounts out of the data. These accounts can then be randomized, if needed, then placed into an audit. This can be accomplished manually or on a preset schedule.

RISK MANAGER

Risk Manager is an artificial intelligence module that translates previous audit findings and hundreds of industry standard coding practices to actual logic that detects and reports on potential issues in the data set that may result in identification of risks or opportunities related to reimbursement. Risk Manager learns from past audit findings to improve accuracy and provide insights to auditing teams. It creates a weighted algorithm that can link findings to other similar issues that may appear in your data set.

INTEGRATION MANAGER

ReviewMate can integrate with multiple sources of data formats including Electronic Medical Record EMR (E.g. Epic, Cerner) systems, HL7 interfaces, EDI 837 files, .csv files and Secure FTP sources.

Integration Manager can automate audit creation and eliminates the manual process of importing data to ReviewMate from spreadsheets. Audits can be created and populated with accounts automatically on a schedule.

DATA CAPTURE

Electronic Data Capture allows the user to create a customized form in which data can be collected that is not already contained in ReviewMate (POC, Admit Source, DNR states, etc)

32% reduction in audit time requirements and cost, on average, to support increase effectiveness and efficiency of the auditor.