Compliance Consulting

The objective of Harmony's Compliance Site Visit is to generate a statistical blueprint detailing elements of risk under medical review.

Site Visits include:

• MDS/PPS Assessments
• Medical Record Accuracy i.e. Medicare UB-04, Private Pay, Medicaid,
• Billing Methodology Audit

Client: This TN based company with LTC facilities dispersed nationally, performs monthly internal audit with regional staff on medical record contents to seek compliance with records.

Issue: This Company noted discrepancies in findings during regional consultant audits and recently received multiple record requests from their fiscal intermediary (Riverbend Government Benefits Administrator) for medical review. The owner of this company contacted Harmony to perform compliance audits in several select facilities in the Memphis, TN area.

Outcome: Harmony dispersed three consultants to the requested homes and performed 9 days worth of intensive compliance audits to provide feedback to the company president. Results of this audit revealed several exposure areas where the facility was at risk for revenue recoupment based on improperly coded MDS section P.

Harmony consultants worked hand in hand the with regional staff from this company to devise a protocol for reporting of therapy minutes across all company owned buildings to ensure accurate coding on the MDS, matched with identical minutes on the UB-04 billing form and filed in the medical record. This newly instated practice improved the company wide reporting of therapy minutes which lended support to billed RUG III scores which were under scrutiny by the fiscal intermediary.