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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.  Already using SentinelTM? Check out our SentinelTM User Group.

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Traditional SentinelTM
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.

SentinelTM Inpatient

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 analytics.

SentinelTM Outpatient

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.

SentinelTM CDM

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.

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