Others Solution
Clinical Documentation Improvement
Clinical Documentation Improvement (CDI) is crucial for ensuring high-quality patient care and accurate reimbursement. Novelite RCM offers expert CDI services to make sure your patient records are precise, complete, and detailed, enhancing diagnostic and procedural documentation for optimal reimbursement. Our team of professionals is rigorously trained to integrate seamlessly with your team across various settings and operational needs.
We are committed to delivering top-tier CDI solutions and helping you achieve and surpass your operational and strategic goals. Explore our comprehensive revenue cycle management services, including medical coding, medical billing, HCC coding, and ICD-10 third-party auditing solutions.
HEDIS Measures Reporting
What is HEDIS?
The Healthcare Effectiveness Data and Information Set (HEDIS) is a comprehensive performance improvement tool used across the healthcare industry, encompassing 190 million people enrolled in reporting plans. HEDIS measures evaluate healthcare performance across six key domains:
- Effectiveness of Care
- Access/Availability of Care
- Experience of Care
- Utilisation and Risk-Adjusted Utilisation
- Health Plan Descriptive Information
- Measures Collected Using Electronic Clinical Data Systems
Novelite RCM HEDIS Reporting Expertise
Our team of Nurse Practitioners and Coders abstract and accurately report on all HEDIS measures (as per NCQA technical specifications) related to Health Plans’ P4P and Star Program initiatives. Our team is trained on Medical Record Abstraction, HEDIS Consulting and is the best in assessing clinical quality measure reporting.
Novelite RCM provides a full suite of HEDIS support services to enhance quality and, star ratings with our full suite of chart abstraction, retrieval, and member engagement solutions including member education, office visit assistance, and others.
Measures are added, deleted, and revised annually. HEDIS data is collected through surveys, medical charts and insurance claims for hospitalizations, medical office visits and procedures. HEDIS results are increasingly used to track year-to-year performance and must be audited by an NCQA-approved auditing firm for public reporting. HEDIS data are useful for evaluating current performance and setting goals. The goal is for providers to submit claims/encounters with coding that decreases or removes the need for the medical record.
Areas of Expertise
- Measures for Medical Record Data collection
- Adult BMI Assessment, Medication reconciliation post-discharge, Care of Older Adults, Comprehensive Diabetic Care, Colorectal Cancer Screening, Cervical Cancer Screening, HEDIS Consulting, etc.
- Abstract Medical Records, Medical Record abstraction on collected data.
- Over reading & Validation
Our HEDIS Measures Reporting Services for Health Plans
HEDIS Abstraction services, enable our Medicare, Medicaid, and commercial health plans customers achieve Star Rating and other Benchmarks. Our services provide the following
- Intervention to impact HEDIS data and timely closure of Gaps
- Pursue Clinical data aggressively to ensure compliance rate
- Care Coordination / education with Physicians to improve effectiveness of clinical care
- Real-time “Gaps in Care” alerts generation
Denials
Denial management addresses claim denials, where a service is refused due to errors, but these can be fixed unlike claim rejections. With denials increasing by 23% over the past four years, efficient denial management is crucial to avoid costly rework. At Ibex Medical Billing, we offer a 94% success rate in managing denials.
Our Denial Management Strategies
Identify
Determine the root cause of denials, either through Claim Adjustment Reason Codes (CARC) or manual investigation by our skilled team.
Manage
- Add denied claims to our task list using automated tools.
- Sort and prioritise work using specialised software.
- Develop and execute action plans for each denial.
- Maintain a checklist of errors to prevent recurrence.
Monitor
 Track the denial management process meticulously, documenting details to ensure accurate submissions and prevent future denials.
Prevent
Use monitored data to implement strategies that prevent future denials, assigning tasks to different teams to ensure efficient workflow and minimise revenue loss.
Compliance Coding
Compliance Coding is crucial in the healthcare and medical sector to ensure accurate documentation, proper billing, and adherence to regulatory standards. At NoveLite RCM, we provide comprehensive compliance coding services designed to uphold the highest standards of accuracy and integrity in healthcare coding.
Why Compliance Coding Matters
In the rapidly evolving healthcare environment, compliance coding plays a vital role in:
Maximises Revenue
Ensuring that all coding practices meet the latest CMS guidelines and payer requirements to avoid penalties and audits.
Accurate Reimbursement
Facilitating correct billing and reimbursement for services rendered, minimising financial discrepancies and claim denials.
Quality Documentation
Supporting precise and detailed medical records that reflect the true scope of patient care and support clinical outcomes.
Our Compliance Coding Services
At Novelite RCM, our compliance coding services are designed to enhance your coding practices and ensure adherence to industry regulations
Expert Review and Auditing
Our certified coders conduct thorough reviews of medical records and coding practices to ensure compliance with regulatory standards and payer policies.
Training and Support
We offer continuous education and training programs for healthcare professionals to stay current with coding updates, compliance regulations, and best practices.
Error Identification and Resolution
We proactively identify and address coding errors or discrepancies to prevent claim denials and optimise reimbursement processes. Ongoing Monitoring and Updates: Our team continuously monitors coding practices and implements necessary updates to adapt to changes in coding guidelines and payer requirements.
With Novelite RCM , you benefit from a team of experienced professionals committed to delivering top-tier compliance coding services. We combine expertise with cutting-edge technology to streamline your coding processes, enhance accuracy, and ensure regulatory compliance. Our focus on quality and adherence to standards helps you mitigate risks, optimise revenue, and maintain the integrity of your healthcare documentation.
Auditing
At Novelite RCM, our auditing process is a cornerstone of our commitment to accuracy and compliance in Revenue Cycle Management. We conduct thorough and systematic audits to ensure that every aspect of your billing and coding processes meets industry standards and regulatory requirements.
Our audits cover a wide range of areas, including coding accuracy, claim submissions, payment postings, and documentation practices. By meticulously reviewing these elements, we identify potential errors, discrepancies, and compliance issues before they impact your revenue cycle.
Through detailed analysis, we pinpoint areas of concern and provide actionable insights to correct errors and optimise billing practices. Our goal is to minimize claim denials, reduce audit risks, and enhance overall financial performance.
We stay updated with the latest industry regulations and coding guidelines to ensure that your practice adheres to all compliance requirements. Our audits help safeguard against potential legal and financial repercussions by maintaining adherence to current standards.
The insights gained from our audits inform ongoing improvements in your revenue cycle processes. We offer recommendations for refining practices, implementing best practices, and enhancing overall efficiency.
By integrating thorough auditing into our services, Novelite RCM helps you achieve higher accuracy, compliance, and financial stability, ensuring that your revenue cycle operates smoothly and effectively.
Compliance and Support: We ensure that all documentation adheres to regulatory and compliance requirements, reducing the risk of audits or legal issues related to inaccurate records.
By utilising our scribe services, Novelite RCM helps enhance provider productivity, improve patient care, and streamline clinical documentation, ultimately supporting the overall efficiency and success of your practice.
Scribe
At Novelite RCM, our scribe services are designed to streamline clinical documentation and enhance overall efficiency in your practice. Our skilled scribes assist healthcare providers by capturing accurate and detailed patient notes, allowing clinicians to focus more on patient care rather than administrative tasks.
Our scribes are trained to accurately document patient encounters, including history, physical exams, and treatment plans. This ensures that clinical records are comprehensive, precise, and compliant with documentation standards.
By handling the documentation process, our scribes improve workflow efficiency and reduce the time providers spend on administrative tasks. This enables clinicians to see more patients and deliver higher quality care without the burden of extensive paperwork.
With a focus on thorough and accurate documentation, our scribes help improve the quality of patient records, which supports better clinical decision-making and reduces the risk of errors or omissions.
Our scribe services integrate seamlessly into your existing processes, working alongside your clinical staff to support a smooth and efficient documentation process.