YES HIM Consulting, Inc. Your Consulting Firm for Auditing, Coding and Education

CDI Mismatch Reviews

Medicare Advantage

Medicare Advantage Insurers Use Reviews to Get Higher Payments

By YES HIM Consulting / December 20, 2019 / 0 Comments

An investigation by the Office of Inspector General (OIG) revealed Medicare Advantage insurers might be overstating patients’ diagnoses without the proper documentation to receive larger payments. Based on the 2016 Medicare Advantage encounter data analyzed by the OIG, insurers were able to get an extra $6.7 billion in payments in 2017.

Read More
Revenue Cycle Management

Clinical Documentation Integrity Significance in Revenue Cycle Management Success in Healthcare

By Mari Cely / November 6, 2019 / 0 Comments

Perhaps the most vulnerable of issues in the Revenue Cycle Management process is the potential for incorrect information creation in a patient’s chart. Data disparities duplicate or inaccurate medical record number recording, and unverified insurance verifications processes in place can potentiate claim denials. Revenue Cycle Management can be thought of as the method of transportation to take an organization from one place to where it needs to go. For the transport to occur successfully and be operationally sound, the processes in place to support it must be accurate and deliberate.

Read More
Query programs backed by data

Case Study: To Query or Not to Query…

By JJ Crumbley / October 12, 2018 / 0 Comments

Across healthcare, the majority of hospitals or healthcare systems have incorporated query programs; however in many cases they are driven solely from a compliance perspective. We’ve prepared a case study using data gathered over the past couple of years, in order to reach an undeniable conclusion: it’s not about the why, it’s about the how.

Read More

YES HIM Consulting, Inc. Largo, Fl.
Office: (727) 531-3839       Fax: (727) 240-4592