Practice Group

Outpatient Hospital

An innovative, proactive approach to coding, documentation, administration, and compliance.

Outpatient hospital visits involve numerous elements, each critical to sustaining great patient care and appropriate payment. These include scheduled outpatient surgery to emergency department visits and associated tests, lab work, x-rays, drugs, and observation. And each diagnosis, procedure, and treatment requires appropriate coding for correct collection. Granite GRC’s Outpatient Hospital Practice Group can help your organization optimize your coding, documentation, and revenue cycle for measurable results.

Addressing Needs and Challenges

Our Outpatient Hospital team assesses documentation for all patient encounters, evaluating for accuracy, consistency, and compliance, with services including:

  • Observation status billing
  • Emergency Department charge capture, including documenting and coding all services (such as injections or infusions)
  • Denials

We bring deep experience in risk adjustment data validation, a keen eye for the nuances of inpatient and outpatient status, and unparalleled expertise in working with the Centers for Medicare & Medicaid Services. We help hospital administrators adopt leading-edge technologies to improve patient service and care, streamline workflow, identify issues, and propose customized solutions, increase receivables, and ensure compliance.

Our focus areas include risk adjustment documentation and coding, CMS and RADV audit preparation, corporate and professional compliance, and advanced data analytics for benchmarking. Further, we assess and analyze systems and transactions; perform, consult on and provide support for internal investigations; evaluate and manage third-party risk, including providing credible, risk-appropriate resolutions, corrective and preventive actions; and more. Our dedicated team is well-versed in all facets of the revenue cycle:

  • Payor contracting, including FFS, PPS, risk adjustment, capitation, bundled payments, value-based, shared savings and other payment models
  • Healthcare revenue cycle management, from credentialing through appeal of denials
  • Concierge and cash medicine models
  • Documentation, coding and billing reviews and analyses
  • Medicare Incentive Payment System analyses and improvement
  • Charge-capture analysis and credit-balance reviews
  • Denials management and appeal
  • Credit-balance reviews
  • UPIC review analyses and responses
  • Voluntary and mandatory self-reporting

We’ll work with your facility and train staff using proven methods, holding ourselves accountable during the process.

  • We immerse ourselves in your practices and procedures, identifying risks, non-compliance issues and areas needing improvement.
  • We develop strategies and training schedules to help your team make and meet goals.
  • We fortify your staff with the tools to improve operations, and understand the best way to implement these strategies.

“Documentation and proper coding are critical steps in every patient visit. Precise and accurate coding and documentation are the foundations of proper reimbursement, strategic planning, fiscal administration and much more. Our team evaluates and identifies potential flaws in your organization’s systems and offers strategies to correct inconsistencies and avert potential problems.”

– from Crystal Stalter, CPC, CCS-P, CDIP, CCDS-O, Director of Revenue Cycle and Compliance

Trusted Guidance, Hands-On Approach

Our trusted advisors are recognized authorities in their areas of expertise, many with more than three decades of healthcare industry experience working inside enterprises similar to yours. They’ve sat in your seat and have known what it’s like to address concerns from inside an organization. We use that experience to work hard to find great solutions that benefit you. Here are just a few examples of how we do things differently at Granite GRC.

 

  • We communicate frequently and transparently with your team about their goals and ensure they understand what’s expected of them.
  • Our strategies help leadership and staff to hold themselves accountable.
  • We measure and monitor progress regularly, and offer reports that let you change course and redirect resources when necessary to eliminate processes that aren’t working and amplify those that are.
  • We streamline operations for greater efficiencies that can improve morale and communication, reduce turnover, and so much more.

“After we identify the issues throughout your organization, together we address your most pressing challenges, recommend solutions and design customer programs and training. We are passionate about helping your team achieve success.”

– from Crystal Stalter, CPC, CCS-P, CDIP, CCDS-O, Director of Revenue Cycle and Compliance

Partnering with You for Success

The certified professionals in our Outpatient Hospital Practice Group are committed to helping you implement strategies in areas that need improvement and make your high-performing areas even stronger.

Solutions to common challenges that we provide include:

  • Assessing the revenue cycle, including documentation and claims review, claims denials and operations
  • Medical litigation review for coding and documentation suits
  • Corporate compliance

Our Outpatient Hospital team has earned respect and praise from clients for identifying issues and pain points, designing solutions to correct problems with measurable results, amplifying best practices, and for outstanding customer support. We measure our success by your success — and we won’t stop until your team has the tools to excel, and the knowledge needed to identify optimal ways to execute these strategies independently.

Success Story

Granite GRC provides audit support for outpatient services such as radiation oncology and observation, using payer standards and policies to review supporting documentation and provide feedback to providers regarding best practices that support payer medical policy.

“We needed an experienced and trustworthy practice group with specialized skills related to healthcare regulations, privacy, and other matters, and the ability to provide practical and actionable guidance to assist in navigating legal and operational challenges. Granite GRC’s team has been wonderful to work with, are timely and responsive and understand the nuances of a challenging and heavily regulated industry. I highly recommend them for their expertise and client-centric approach.”

– from Rafael M. Villalobos, Jr., Esq./MBA, Deputy General Counsel, Litigation and Risk Management Capital Health System

Meet the Outpatient Hospital Team Lead

Crystal R. Stalter, CPC, CCS-P, CDIP, CCDS-O,

Director of Revenue Cycle and Compliance; Outpatient Hospital Team Lead

Author, speaker and Director of Revenue Cycle and Compliance Crystal Stalter is nationally recognized as an authority in healthcare best practices, medical coding, clinical documentation, natural language processes and artificial intelligenc  (AI). She brings 20 years of experience in revenue cycle management, compliance, practice management, strategy, training, coding operations, communications, data analysis and more, providing superior guidance and helping healthcare professionals achieve excellence in facility management and patient care.

Download service overview PDF or schedule a free consultation