SentinelTM represents a bundled consulting service
and web-based product suite to strengthen your Revenue Cycle Management
initiative, specifically focusing on Inpatient and Outpatient claims
and/or Chargemaster. Available as an outsourced service or an on-site
web tool, the Hospital is empowered to identify and resolve opportunity
for more accurate, complete and compliant billing. The underlying expert logic of SentinelTM is based on our extensive field experience assisting hundreds of hospitals nationwide to identify and correct coding and billing inaccuracies. PCS continuously analyzes state and national data files to establish normative baselines and expected charging and billing patterns.
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Be Empowered. SentinelTM allows you to easily focus on
inpatient and outpatient claims with potential revenue impact or
significant compliance risk.
New Option! Outsourced SentinelTM
Leverage simplicity - With a virtual team of inpatient and outpatient coding and billing experts monitoring patterns while regularly reviewing 100% of your billed claims.
The need to manage and review the Inpatient population is inspired
by federal (MS-DRG) and state (APR-DRG) regulatory changes, increasing competition with neighborhood
ambulatory surgery centers, tougher negotiation with private payers,
and a growing self-pay population. Diminishing admissions together
with lower length of stay require a Revenue Cycle Management initiative
that monitors coding, utilization management, charge capture and
compliance with regulatory programs such as RAC. Monitor one-day
surgical stays, which represent one areas of RAC focus, while identifying
opportunities for more specific diagnosis assignment.
Identifying and prioritizing clinical documentation needs along
side opportunities for more accurate coding, SentinelTM Inpatient is available as a web-based or outsourced service,
with targeted chart review accompanied by profiles and various hospital-level
Outpatient services represent a growing proportion of the Hospital
reimbursement pie, and with regulatory initiatives such as RAC present
for multiple year audit review, it is paramount to monitor both
opportunity for reimbursement as well as exposure to compliance
risk. Our web-based tool reviews outpatient claims across all payers,
identifying opportunity for charge capture, coding and/or compliance
with regulatory initiatives. Compliant to both the national
(APC) and state (APG) payment methodologies, SentinelTMs logic is based
on our extensive field experience assisting hundreds of hospitals
nationwide identify and correct charging, coding and billing inaccuracies.
By clearly identifying the expected fiscal impact of potential issues
and opportunities, SentinelTMallows you to easily target
claims with significant compliance or reimbursement impact.
Whether you take advantage of our quarterly desk audit services,
or prefer a comprehensive CDM review, SentinelTM ensures that you
are billing appropriately for all services performed, while monitoring
charging practices as compared to a custom peer group. Integrated
within the SentinelTM product suite, SentinelTM CDM identifies missing
services and applies proprietary edits to the CDM to ensure that
all services are billed completely and charged appropriately. Missing
services, charging practices, HCPCS assignment, modifier utilization
and payer-specific billing practices represent just a few areas
of focus. Automated review services are complemented with on-site
interviews with appropriate personnel to ensure completeness of
billing from order entry through the claims submission process.
With a comprehensive set of proprietary edits, and a team of professionals continuously dedicated to staying on top of coding policy and federal regulation, Provider Consulting Solutions has the right solution for you. SentinelTM is currently available for on-site installation and support, outsourcing and Charge Description Master Review.