Revenue Cycle Management

HMI’s Consultants review revenue and usage data to identify reimbursement enhancement opportunities, reduce costs and improve outcomes. We also identify missing charges/codes and address revenue impact associated with areas of non-compliance.

				
			
Revenue Cycle Management

Revenue Cycle Management

On-Site Consultation Services HMI consultants provide on-site services for CDM update, implementation and education, bill audits, rejected claims, reviews and resolutions, operational assessments, bill audits, system implementation and process improvement.

Charge Capture ServicesOur consultant specialists review the entire medical record for the observation stay to identify and report the hours for observation, drug administration services, and any other procedural services ordered and performed. The hours of observation are calculated in accordance with CMS guidance and drug administration services are coded in accordance with current coding guidelines and CMS guidance.

Comprehensive Chargemaster UpdateThis review includes analysis of inpatient and outpatient charges and all clinic charges maintained in the CDM and impacted by CMS PPS. HMI will review all CDM line items for accuracy of the CPT®/HCPCS, UB revenue code, and modifier assignment for compliance with federal and MAC/FI rules and regulations, price comparison vs allowable reimbursement levels and descriptions for meeting hospital’s internal standards. HMI will identify all line items for addition, modification, and deactivation, as well as price comparison vs. allowable reimbursement levels. Concurrently, we will provide a coding and billing helpline by phone, fax, or email for the term of the contract.

Emergency Department (ED) Facility E/M ServicesOur consultant specialists will assist the hospital in the development and implementation of a facility resource-based criteria and charging tool for the purpose of objectively assigning ED visit levels and procedures. This service will include educational resources to staff relating to outpatient ED services for compliance with CMS rules and regulations.

Ambulatory Surgery (ASC) Claims ReviewOur consultant specialists will validate the CPT©/HCPCS and ICD-9-CM/ICD-10-CM diagnosis coding and modifier (if applicable) assignment for surgical services and drugs used during procedure. The medical record documentation is reviewed against the ASC final billed claim to confirm reporting accuracy. The review will include an assessment of documentation quality for supporting medical necessity.

Ground Ambulance Claims ReviewOur consultant specialists will validate the billed HCPCS codes, origin and destination modifiers, provider arrangement modifiers (if applicable), loaded mileage, and verify the diagnoses codes reported to Medicare against the patient trip record.

Home Health Agency (HHA) Claims ReviewOur consultant specialists will perform a comprehensive review of the home health documentation to validate the billed HIPPS code, HCPCS codes for visit disciplines (SN, PT, OT, SW, etc.), units, diagnoses codes, and billable supplies. A thorough review of the medical record documentation against the hospital final billed claim will confirm reporting accuracy. The key documents such as the OASIS, plan of care, and face-to-face certification are reviewed for completeness and accuracy in accordance with the episode of care.

Hospice Claims ReviewOur consultant specialists will perform a comprehensive review of the hospice documentation to validate the billed HCPCS code for service location, HCPCS codes for visit disciplines (SN, CNS, SW, etc.), units, diagnoses codes, and billable supplies. A thorough review of the medical record documentation against the hospital final billed claim will confirm reporting accuracy. The key documents such as the certification of terminal illness, plan of care, and Interdisciplinary group (IDG/IDT) meetings are reviewed for completeness and accuracy in accordance with the episode of care.

Skilled Nursing Facility (SNF) Records ReviewOur consultant specialists will perform a comprehensive review of the patient medical record to ensure all charges are captured appropriately, reimbursement is optimal for the services provided, and a schedule exists for filing the minimum data set (MDS) and claims in a timely manner.

Inpatient Rehabilitation Facility (IRF) Records ReviewOur consultant specialists will perform a comprehensive review of the patient medical record to ensure that the IRF admissions were appropriate to meet medical necessity and the documentation and staff services satisfied the minimum CMS requirements. The review will confirm all the requirements for are met for completing the preadmission, physician admission order, history and physical, individualized plan of care, interdisciplinary team meetings, IRF patient assessment instrument (PAI).

Charge Capture – Other Ancillary Services – Outpatient Interventional Radiology, cardiac catherization and ED Review our coding specialist will review the medical record for interventional radiology cardiac catherization, and/or ED and report appropriate CPT/HCPCS procedure codes and diagnosis.


Coding and Billing Helpline

Objective: To provide a helpline resource for the provider community to address coding and billing questions that may arise during day-to-day operations. HMI will answer questions using the most current coding guidelines and published CMS billing guidance.

Resource: our consultant specialists will be available to answer questions via an e-mail service related, but not limited to the following:

● Chargemaster

● CPT©/HCPCS/UB revenue codes

● Modifier application

● OPPS billing

● CCI /MUE / Device and Procedure Edits

● Medical necessity

● Physician E/M billing

The current guidance utilized by HMI to respond to questions will be communicated via e-mail. This allows the individual to have access to these resources for future reference on related issues. Additionally, HMI will address within our e-newsletter, Coding and Billing for Prospective Payment Systems, common coding and billing questions that are submitted through the helpline.

Warranty: Every effort will be made to respond to questions within a to 72 hour period and ensure the accuracy of the helpline responses. HMI’s helpline responses will be supported by the most current CMS guidelines available. HMI’s interpretation of the CMS guidelines may not always agree with the Client’s local MAC/FI. When HMI has direct access to the MAC/FI Part A or Part B guidelines, we will provide the most straightforward response available.

It is the client’s sole discretion to apply current guidelines to its coding and billing practices based on the information provided.