An Unexpected but Critical Assignment for PHS: A Case Study

Paramount Health Solutions offers maximum value to clients. We strive to develop partnerships based on trust and open communication. We provide quality, sustainability, and ROI with each customized arrangement with clients.

Here are some of the key offerings we provide:

  • A pricing model that shares risk with the hospital
  • Physicians reviewing the charts, yielding “full scope” reports of findings, trends, and patterns
  • In-depth knowledge of clinical documentation, coding, compliance, and the very latest coding standards and rules
  • Guaranteed pre-bill chart review and response within 24 hours or less from the time it is received
  • Exact, specific reasons for our queries
  • For any of our recommendations denied by a payor, we draft appeals to counter the denial at no additional cost to the client
  • A second level of review to supplement the work of the hospital’s HIM staff to potentially catch errors, omissions and/or missed opportunities
  • Customized training for physicians and staff to help improve practices, address deficiencies, and continuously enhance HIM and compliance for overall program success

Beyond our usual and customary services, PHS recently was given an unexpected but crucial assignment from one of our clients.

The rapidly changing coding guidelines during the COVID-19 pandemic have caused confusion and uncertainty among hospital coding professionals. In addition, the government is stepping up audits.

Prior to engaging with us, the hospital in this case self-reported to the HHS Office of the Inspector General (OIG) that they improperly billed claims to the COVID-19 uninsured program. Specific billing items in question included: 1) Testing, treatment, and vaccine administration for patients without a COVID-19 primary diagnosis: and 2) Pregnancy with COVID-19 as a secondary diagnosis.

After we were brought on by the hospital, Paramount worked with their team to draft an OIG rebuttal regarding the HRSA COVID-19 claims.

PHS’s method of using physician-led chart reviews ensured that comprehensive audits of both coding and clinical validation were conducted on the claims in question. The insights and compliance-related data found in the charts by the PHS physicians enabled them to write a point-by-point response to the OIG on behalf of the hospital.

The results – OIG accepted Paramount’s recommendations and findings. Part of the correction plan for the hospital was that PHS would continue to review all COVID-19-coded charts. The PHS team continues to successfully keep this client’s COVID-19 billing compliant with OIG standards.

PHS provides key services to help hospitals. Not only does PHS increase billing opportunities, but we also assist clients with payor denials for any of our recommendations that are not accepted, and we play a leadership role in managing and responding to compliance issues.

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