The program includes analysis of Client’s outpatient/ancillary services and clinic services impacted by CMS OPPS: review of entire CDM for outpatient/ancillary (including clinics) line items for accuracy of the CPT/HCPCS, UB revenue code, and modifier assignment for compliance with federal and fiscal intermediary rules and regulations, price comparison vs. allowable reimbursement levels, and review descriptions for meeting Client’s internal standards. Additionally, our consultant specialists perform reviews of outpatient medical records and billing documents to ensure coding (ICD-9-CM, CPT, HCPCS) compliance with current guidelines and optimal reimbursement from all payors.
The scope of the engagement may include monthly, bi-monthly, or quarterly on-site services with our consultant specialist who will provide technical expertise to include:
Comprehensive outpatient chargemaster departmental reviews
Charge screens/order entry reviews corresponding to CDM maintenance
Reviews and updates for department charging tools
Bill audits for outpatient services
Medical record reviews for outpatient services
Continuing education for hospital staff
Implementation and quantification of recommendations
Coding and Billing Helpline provided at no additional cost during the term of the contract. Client’s staff may take advantage of this helpful service to communicate directly with their on-site consultant specialist when billing and coding questions arise from daily operations.