OMCA Hits 60 to 1 shot!
For several years now many of our clients have arranged for our nurse case managers to perform in depth hospital medical records audit. These are performed by our most experienced nurses who have knowledge not only of treatment plans and medical records but also have “real world” experience in the operating room, recovery room and on the floor. This gives them extra insight into how hospital/surgical care is delivered, territory that is truly foreign to most of us.
Our nurses have two major points of focus. First, is there documentation that each and every service for which we were billed was actually delivered? This could be reflected in the patients chart, OR/Recovery room notes, anesthesia records, etc. — this often requires inside knowledge to know where to even look for this information.
Secondly, is the service provided one that was necessary for the treatment of the condition for which we are responsible? For instance, if our work comp claimant had a bad knee and a bad kidney, we approve services for the knee but disallow services for the kidney.
Recently I submitted an 8-month report to one of our clients documenting $800,000 in disallowed charges. Our fee for this was $13,000. Some of these charges will be appealed, some ultimately will be allowed. But at this point, our client is thinking that a 60 to 1 return on investment is a pretty good start.
Are your nurse case managers giving you the right return on your investment or does every service feel just like “even money”?
Call us, We can do better.
Posted in OMCA