Paramount Health Solutions’ “Organic Chart Review” Process Limits and Prevents Claims Denials

The physician experts at Paramount Health Solutions employ an “organic” review process to pinpoint errors and omissions in clinical documentation. This review type is different and more accurate than a “traditional” chart review, and reflects the deep knowledge and understanding that we bring to the process.

Most coders are looking at the verbiage used in the documentation and translating the exact words into the DRG codes. They code what they see, including, unfortunately, “copy and paste” errors that frequently occur in the EMR.

As physician CDI/DRGV specialists, we analyze the meanings behind the words and look at the whole picture of patient care. When we see something that is not clinically valid from a physician, such as a copy and paste error, we know that it doesn’t make sense. Or we find something that does not meet the definition of a diagnosis.

When there’s lack of evidence in the physician documentation for a diagnosis, it is denied by the payer. We provide a second level of review and find query opportunities missed by coding staff. Our record is an 80 percent and higher physician acceptance rate of our recommendations with physicians we work with at client hospitals.

In summary, a physician-led “organic” CDI/DRGV process like ours will catch errors and omissions in the charts that trigger denials and audits. With PHS, it’s not only about a DRG change and reimbursement, it is also about compliance.

We’re trained and experienced in both the clinical and coding domains. We guarantee that if any of our recommendations are denied by a payer, we will write an appeal on behalf of our client, whether it be a first level, a second level, or a third level of appeal. We want to make sure we’re guaranteeing that the most appropriate bills are being submitted for the charts that we have reviewed.