MEDICAL
AUDIT RESOURCE SERVICES, INC.
Proposal for Comprehensive Review Services
SERVICES AGREEMENT
This Services Agreement ("Agreement") is made this 07 day of May
2008 by and between Medical Audit Resources, Inc. ("MARSI"), and
Inform Worldwide Holdings, Inc., its affiliates and subsidiaries
("IWWI"). MARSI and IWWI may be referred to herein each as a
"Party" and collectively as the "Parties".
I.
RECITALS
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A.
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MARSI is in the business of providing coding, quality of care and
physician documentation reviews and services to the health care
industry.
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B.
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IWWI, for itself and on behalf of its affiliates, subsidiaries and
other related entities (including PrimaCare Corporation and Medical
Resources, LLC), and other entities that IWWI may hereafter
acquire, and on behalf of the health care providers identified in
Exhibit A hereto that are managed by IWWI or an affiliate thereof
and which have given their consent to be bound by this Agreement
(providers which give their consent are referred to herein as the
"Contracted Providers"), desires to obtain from MARS I certain
services and materials on the terms and conditions set forth
below.
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II.
About MARSI
Medical Audit Resource Services, Inc. (MARSI) has fifteen years of
experience working with physicians, managed care entities and a
variety of other health care professionals, with a focus on
accurate, defensible coding and clinical documentation components
and how they relate to reimbursement and quality of
care.
The experts at MARSI can provide assistance with the intricate
complexities of coding rules and regulations, and assist management
in its efforts to guide and educate its physicians in proper,
efficient, accurate and comprehensive documentation.
We have provided these services to clients nationwide for nearly
fifteen years. MARSI has utilized the expertise of many
professionals, and experience with many healthcare systems to
develop the most comprehensive review programs available.
Additionally, MARSI has assembled a core team of physicians to aid
in the education of physicians from a peer perspective. MARSI
believes the interrelated areas of physician documentation, coding
compliance and quality of patient care must be evaluated as a
group.
We propose to educate, train, monitor and report on all aspects of
ongoing efforts to change documentation habits of IWWI' s
physicians to achieve the following results:
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Decreased
risk of over-coding
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·
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Increased
identification of HCCs
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·
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Improved
physician documentation
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Improved
team support of individual patient visits
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MARSI's
goal is to deliver more than is expected. During the course of
this engagement we will:
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Compare
all aspects of the physician documentation with the existing
diagnosis codes
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Make
recommendations for accurate correction of incorrectly coded
patients
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Educate
physicians on how to improve accurate and comprehensive
documentation skills
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Reinforce
to the physicians the financial considerations of accurate and
comprehensive documentation
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Consult
with the plan or group to initiate permanent solutions to
documentation and quality of care problems
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Help
migrate the plan or group into Comprehensive Disease
Management
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III.
Scope of Work
MARSI
will perform statistical and algorithmic analysis of data
provided by IWWI to aid in the identification of potential
outlier trends. MARSI will provide specific data parameters
and elements for inclusion in this data. Through the results
of this analysis, MARSI will identify specific encounters for
review. Additional encounters will also be selected by MARSI
for inclusion in the review based on our experience and areas
known to be problematic.
MARSI
will provide team members on-site at the facility to scan the
medical records into MARSI's server. From there, our team of
professionals will review the medical record and physician
documentation focusing on the following
areas/components:
IV.
Services
A.
HCC / Risk Adjustment
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2.
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Patient
specific recommendation to be placed in chart
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3.
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Reporting
for each physician and total
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4.
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Full
reporting, including ROI
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B.
Quality of Care
1.
Does the physician:
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a)
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Identify
all patient problems?
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b)
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Consider
possible diagnosis
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c)
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Develop
a plan for each problem?
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d)
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Follow-up
on each problem?
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2.
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Is
the physician thorough?
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3.
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5%
will be reviewed by MARSI physicians
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C. Physician Education
and Documentation Improvement,
specifically;
C.
I. Quality promoted by documentation
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2.
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Identification of diagnoses: facilitated by
documentation.
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3.
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Disease management: plans and documentation
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4.
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Medical necessity supported by documentation
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D. Ongoing Physician Compliance Program
I. Provide physician "help line" to increase
physician compliance
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2.
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Monitor physician compliance: monthly compliance report showing
action taken on recommendations
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3.
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Promote physician compliance: follow-up by MARSI and IWWI staff to
insure that appropriate action taken on recommendations by
physicians
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4.
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Personal communication with physicians to increase
compliance
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E. Independent Audit Committee
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I.
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MARSI will chair and provide members to an independent audit
committee which
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will provide the following functions:
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d)
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Medical management / Disease management
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2.
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MARSI and the committee will identify needs/problem areas as
above
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4.
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MARSI will generate a monthly report of findings
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5.
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Physician/Provider Training
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a) MARSI will assist in training/retraining of physicians and
providers
6. Independent Audit Committee Ongoing Audit
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a)
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MARSI will audit for ongoing improvement based on the corrective
action plan generated by the Independent Audit
Committee
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V.
Other Services
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A. Non-Risk / Fee for Service: as mutually agreed upon I. CPT
review
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2.
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Medical necessity reviews
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3.
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Documentation Improvement
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4.
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Physician education (over codes &
under codes)
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VI.
Methods
& Processes
A. Scanning records
B. Review by MARSI experts
C.
Reports
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1.
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Patient
report to office
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2.
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Placed
in each reviewed chart
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D.
Compilation to PrimaCare monthly
E.
MARSI physician review
F.
Physician education
MARSI
will utilize highly skilled coding experts for the majority of
the reviews, except:
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