PIA™

PAYMENT INTEGRITY AUDITING

How Healthy Is Your Providers’ Coding?

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Ensure your payment integrity through HCC Management solutions

Payment integrity amounts to a $100 billion annual problem nationally. The demands have increased, especially since the Medicare Modernization Act of 2003 now requires that CMS reimbursements be rendered based on HCC risk adjustment.

Outcomes Health has a solution: Payment Integrity Auditing (PIA™) to assist organizations with HCC management. Harnessing the power of ODIS Alert™, we provide an end-to-end solution by processing data from disparate sources in many formats, improve it with the clinical data we harvest from the health record and provide analytical services to all kinds of healthcare organizations. Outcomes Health then makes the data available to clients on-demand through our proprietary technology. PIA™ delivers results for projects such as:

  • HCC Risk Adjustment Audits
  • Medicaid Payment Compliance Audits
  • Evaluation & Management Audits
  • Emergency Department Audits
  • DRG/MS-DRG Audits
  • Risk Adjustment Data Validation (RADV) Audit Support

 

There’s no mystery when Outcomes Health conducts a Payment Integrity Audit. With Outcomes Health, it’s simple: you see the data when we see the data – at the member, provider, and organizational level.

Some medical informatics solutions providers rely on contractors to retrieve and analyze data for HCC management, potentially missing valuable data elements and codes. But Outcomes Health’s Clinical Audit Team is made up of nearly 300 experienced auditors, nurses and certified coders, who are specifically trained in HCC risk adjustment payment methodologies, ICD-9 CM and other coding guidelines as well as accreditation standards such as HEDIS®.