Clinical Services 2018-02-22T14:57:20+00:00

Clinical Services

Audit Services

Audit activities provide critical data for leadership to refine practices to enhance compliance and protect organizational assets. Education and expert consultation are provided to ensure customized support with focused audit outcome data.

RBC Limited Audit Services:

  • Comprehensive, integrated, organizational report review to identify inconsistencies that may hinder both agency compliance and outcome goals. Includes a review of all CMS CASPER and PEPPER Reports, as well as benchmark and software vendor reports. Additional focus on outsourced vendor activities and reports as indicated by organizational infrastructure.
  • Focused Clinical Record Review:
    Identify inconsistencies and opportunities to strengthen documentation to support quality care and services;
    Strengthen provider efforts to minimize audit trends.
  • Clinical Compliance Audits:
    Broad Spectrum Approach to identify clinical practices that hinder corporate compliance including Quality Review of Clinical Records, Coding Practices and Outsourcing Outcomes.
  • ICD-10-CM and OASIS Clinical Record Audit:
    Focused Audit to identify organizational accuracy index on key clinical record items that impact both agency reimbursement and quality outcomes.
  • ICD-10-CM and MDS Clinical Record Audit:
    Identify trends that may adversely impact agency reimbursement and quality outcomes, including CMS STAR ratings;
    Focus priority initiatives to minimize adverse trends and strengthen accuracy rates to ensure accurate reimbursement and accurate quality outcomes and STAR Ratings.
  • Focused Clinical Record Audits to Identify Opportunities to Strengthen Practices to Mitigate Audits, Denials and Downcodes.
  • Consolidated Clinical and Billing Audits to Strengthen Compliance Initiatives.
    Due Diligence clinical record audits to support Merger and Acquisition initiatives.

STAR Gazer Services

Many post-acute providers are now experiencing an impact on referral patterns and contracts based on their current transparent CMS STAR Rating.

Your STAR Rating will impact your business in this transforming healthcare system of vertical and horizontal integration.

  • RBC Limited STAR Gazer Services:
  • Identify agency strengths & opportunities to enhance practices that drive outcome achievement;
  • Perform STAR Gap Analysis to specify processes and practices that hinder and enhance quality outcomes;
  • Strengthen agency use of infrastructure resources, including software and benchmark programs, that support Star Progression;
  • Educate and train leadership & staff on the fundamentals of Value Based Performance & STAR Initiatives;
  • Provide resources, tips & tools to enhance Star Achievement;
  • Ensure access to available expertise and resources that hasten goal achievement;
  • Maximize agency Quality engines to ensure process revisions that support Star Goal Progression.

OASIS/Inter-Rater Reliability Services

Data integrity and consistency in completing OASIS documents is one of the single highest priorities for certified home health providers today. Accurate reimbursement and quality outcomes hinge on accurate, consistent data, including the accurate assignment of ICD-10-CM diagnosis codes. The initiation of the revised OASIS-C2 documents poses challenges for the home care industry, with quarterly updates that continue to threaten OASIS data integrity. Ongoing agency surveillance and reinforcement to monitor and enhance accuracy and consistency with critical assessment items is vital for OASIS data integrity.

RBC Limited provides the following OASIS Services:

  • Perform an OASIS Data Integrity Gap Analysis to determine the agencies internal consistency with responding to all OASIS items;
  • Customize interactive clinician and reviewer OASIS Programs that target identified agency goals;
  • Implement Inter-rate Reliability Programs that embed OASIS Best Practices and enhance OASIS accuracy;
  • Develop and/or implement strategic OASIS oversight Programs to ensure client success on identified goals;
  • Provide onsite and/or remote expert guidance to oversee outsourced OASIS and ICD-10-CM Code services;
  • Perform surveillance audits on outsource vendors to track and trend audit services accuracy and impact outcomes.

In addition, RBC Limited can assist with:

  • Infection prevention and control education, plan development,
  • Occupational Exposure,
  • QAPI enhancement,
  • Best Practice Development,
  • Pain Management Strategies/ Opioid Use Education.

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