Review Types
Recovery Audit Solutions, Inc. (RASI) can review a host of services, including but not limited to medical chart review, DRG validation and medical necessity of admission. RASI reviews the appropriateness of billing by looking for excessive units billed, code definitions, medically reasonable limits or limits imposed by policy. RASI also reviews to make sure all coding was correctly billed, which includes review for unbundling of services, duplicate billing, and inappropriate modifier usage.
Appropriateness of Billing
Correct Coding
DRG Validation
Outlier Review
Medical Necessity of Admission
Medical Necessity of Services
Medical Chart Review
Case Study
DRG Clinical Validation Review
– Case Description
Clinical validation reviews are based on documentation noted within the patients’ medical records. RASI collaborates with our clients to create clinical policies for specific diagnoses and procedure code requirements. Using those policies, RASI applies their proprietary algorithms to identify coding irregularities in the claims data.
Summary
Benefit
$18,888.12 dollars recovered
Improved internal processes
Increased future revenue
Final Result
New Payment Amount: $11,397.02
Savings: $18,888.12