With our medical controlling services, we support you in order to:
Significantly increase the quality of your coding and documentation.
Promptly process your open cases and Medical Service (of the Health Insurance Funds) requests.
Optimise your revenue in the long term.
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Who we are
‘SEARCH PARTY’ FROM THE RHINELAND
Medical controlling is our passion. We support health facilities in securing revenue and being economically viable. Our activities encompass all issues relating to securing revenue through coding review, ensuring liquidity through on-site primary coding and support in the area of Medical Service (of the Health Insurance Funds) management. The strategic orientation of the respective facility is also one of the issues that we handle. As medical controllers, we are service providers and a link between the management and the health facility or department. We bring all of the parties involved in the process together so that the medical controlling can be performed efficiently and without time wasted due to conflicts and miscommunication.
Our first review step is always free of charge and non-binding. You will receive an initial overview of revenue potentials before the start of the project.
We would like to support you professionally and reliably in the ensuring of the stability and growth of your hospital …
Our first review step is always free of charge and non-binding. You will receive an initial overview of revenue potentials before the start of the project.
Our bottom line: Code reviewing is always worth it!
How are reviews performed?
The coded cases from the previous day are viewed by us on a daily basis. The dataset according to §21 of the KHEntG (German Hospital Fees Act) from the previous day is automatically recorded by MetaKIS for this.
The cases within normal limits are directly released by us in the system for billing. This means that no gaps result in the billing chain and your employees do not have to exert any additional effort on site.
The cases are released early in the morning. We make sure that all cases are billed by 8:30 in the morning.
We assess abnormal cases within 24 hours. We receive feedback on whether the theoretical abnormalities are also seen in practice or whether the case was properly coded despite the arithmetical abnormality.
Starting situation: There are undiscovered sleeping potentials
Every day you receive notices of reviews aimed at reviewing your billing in order to identify savings potentials. This causes you to pay back a lot of money to payers. It doesn’t have to be that way:
Our services
We review your billing data in order to uncover sleeping potentials for revenue
Your data run through targeted formal, statistical and medical validation rules
A list with cases containing savings potentials is thereby generated
Our experienced employees assess the cases holistically on the basis of the full medical record
We uncover additional revenue potentials
We look for optimisation potentials relating to documentation that meets the requirements of the Medical Service (of the Health Insurance Funds) and improvements in the workflow
YOUR BENEFITS
You can once again settle accounts for cases showing additional revenue potentials with the payers.
Knowledge-transfer through the presentation of our results within the framework of a team meeting
We discuss the abnormalities and coding proposals of our employees together
For each case with revenue potentials you receive the information required in order to be able to successfully defend the case in the event of a potential audit of accounts.
Medical Service (of the Health Insurance Funds) management
Starting situation: Revenue risk is growing
There is the option to have the entire Medical Service (of the Health Insurance Funds) processing ensured by us through the audits of accounts preceding the case-related review.
Our services
Support provided on site or digitally via a secure Internet connection (VPN)
Discussion of the proposed changes with the employees on site
Support of the Medical Service (of the Health Insurance Funds) procedures resulting from our coding change
YOUR BENEFITS
Prompt case version with qualitative feedback within the framework of possible optimisation potentials
For the health insurance providers, the cases billed ‘normally’ are without reference to review and the associated higher probability of audit
According to §275d SGB, only verified complex treatments may be billed from 2022. Positive certification by the MD(K) is essential for future billing. Hospitals are therefore strongly recommended to evaluate the complex codes relevant to their audits in good time. We will be happy to support you in the preparations and in the process of a successful MD(K) structural audit.
We are pleased with the trust placed in us and with our constructive co-operation. Please get in touch with us if you would like to contact one of the following people.
Here is a selection of our references for the area of coding review and primary coding: