Utilization/Coding
Utilization management, coding/DRG assignment, and billing compliance
Stratis Health has over 30 years of experience and expertise in utilization review, billing compliance, coding and DRG assignment. Our expertise stems from our ongoing contract with the Centers for Medicare & Medicaid Services (CMS) as Minnesota’s Quality Improvement Organization (QIO). Our goal is to promote quality improvement and patient safety.
The Stratis Health staff who carry out this work bring a diverse clinical and professional background with experience in inpatient and outpatient hospital care, long-term care, home care, health information management, coding, case management, geriatric medicine, and quality improvement. Stratis Health maintains a network of physician consultants in a variety of specialities in order to deliver complete and unbiased peer review, answer questions of appropriateness of care, quality of care, medical necessity and appropriateness of coding.
Stratis Health’s goal in this process is to promote quality improvement and patient safety by assisting hospitals in identifying opportunities to fine tune clinical decision making, improving level of care assignment decision-making and documentation as well as ensuring billing compliance is maintained. For more information, refer to the following links:
Resources
The following resources are intended to assist your organization in its utilization management, coding/DRG assignment, and compliance activities.
Medlearn Matters. Part of the Medicare Learning Network, this searchable database contains articles needed to explain and support CMS transmittals.
Office of Inspector General (OIG)—Department of Health and Human Services Workplan. Describes OIG work activities, organization and work planning process for FY 2012 in order to promote economy, efficiency, and effectiveness in the administration of the Department of Health and Human Services’ program offerings. (115-page PDF)
Noridian Administrative Services– Medicare Administrative Contractor. Site offers news, publications forms and training as well as information on claim submissions,
medical review activities, and appeals.
Professional organizations and health information management (HIM) industry information
Advance for Health Information Professionals. The nation’s leading newsmagazine for HIM professionals. Provides news, career guidance, product information, continuing education opportunities and job listings.
American Academy of Professional Coders. AAPC provides certified credentials to medical coders in physician offices, hospital outpatient facilities, ambulatory surgical centers and in payer organizations.
Health Care Compliance Association. HCCA exists to champion ethical practice and compliance standards and to provide the necessary resources for ethics and compliance professionals and others who share these principles.
Minnesota Health Information Management Association.
MHIMA is committed to the professional development of its members through education, networking, and life-long learning. These commitments promote high quality health information and benefit the public, health care providers, and other clinical data users.
Minnesota Hospital Association. MHA’s mission is to enhance the ability of members to achieve their mission and goals by offering the following services: advocacy, communications, data and information services, education, finance and general counsel.
Contact Stratis Health for assistance with your quality improvement and patient safety needs.
If your organization has projects it would like to work on, contact us to discuss how we can work together to support utilization management.
Contacts
Betsy Jeppesen, vice president, Program Integrity
(952) 853-8510
Jodi Winters, program integrity assistant
(952) 853-8513
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