The Opportunities

• Undercoding
• Under Submissions
• Under Reimbursement
• Never Submitted 

Finding Significant Increases

Historically, we have found significant increases in reimbursement for our clients even after reconciling over submission and our fees —  from $100 - $300 PMPM.  But, this is not just “low hanging fruit” of “diagnosis last year, none this year” or medication cross walk.  We do that, but much more.

This is an “eyes-on” review that finds conditions that should be documented, coded and submitted.  This takes “reading between the lines.”  it also highlights the knowledge deficits of each physician.

Resulting in Further Submissions

Our findings generate queries to the physicians that not only result in further submissions, but, also, reinforces MARSI physician training — chart-by-chart.

A Refined Process

Our process identifies all of the possible ICD-9 Dx that should be or should have been submitted.  All of our clients have some codes that were never submitted, but should have been.  With one client, that was 40% of all codes that were clearly documented and defensible.  Regardless, the “hidden” diagnoses and codes that should be submitted, that are not found without “eyes-on-the-chart”, account for an average of twice as much as the codes already submitted. 

For an explanation of “why?”, please see Problems and Challenges.