The OIG has released their workplan for 2006 listing special areas of concern (www.oig.hhs.gov/publications/workplan.html. Providers should pay particularly close attention to the areas that represent concrete targets. For hospitals this includes payments made to hospital under OPPS and inpatient claims. Skilled nursing facilities and physician offices are also impacted. In addition on January 11, 2005, CMS announced the Recovery Audit Contract (RAC) which is targeting hospitals in California, New York and Florida. Do you sense there are issues? ..... Since APCs, many hospitals have discovered that they are not capturing all of their charges appropriately~ Accurate charge capture under APCs has not been easy.... Let us help your staff... by validating processes and enhancing your staff's knowledge through training. We also provide:
In-Depth Laboratory Consulting - We provide coding guidence relative to laboratory services for hospitals, reference laboratories and blood banks. Determine whether you are billing for every assay in a custom panel profile; billing microbiology with additional identification and sensitivity testing; assigning method specific CPT codes and reporting the CPT defined unit for each antibody and assay; adhering to correct coding and national coverage policies. Are your efforts resulting in your receipt of appropriate payment?
Outpatient Observation & One-Day Stays - Let our clinical consultants work with your case management staff to put the policies and procedures in place to proactively monitor the billing of outpatient observation services.
Emergency Department Work-Flow and Coding - Are you reporting and capturing all of your emergency department charges? ED, physician documentation may impact all areas of your hospital - even the most appropriate DRG assignment. Is your facility E/M coding reflecting the resources utilized in your emergency department? We can help you by working with your clinical, business office and HIM staff to ensure that your are appropriately capturing your charges in your ED.
Chargemaster-Driven Record Review - Does the documentation in the chart support the chargemaster assigned codes and result in appropriate reporting? Difficult areas include interventional radiology, cardiac cath and laboratory.
Case-Management/DRG Validation - While attention has shifted to APCs, case-management and inpatient coding has been understandably neglected. Make certain that you are still efficiently managing your inpatient and outpatient utilization and assigning the most appropriate DRG.
Skilled Nursing Facility Operational Reviews, MDS/RUG Reviews, Clinical Reviews, Due Diligence and Education, Develop and/or edit Plans of Correction and Informal Dispute Resolution, Conduct mock surveys, Interim DON, MDS Coordinator
Inpatient Pschiatric Case Management and Reimbursement Reviews
Interim Director of Nursing for Acute Care and Skilled Nursing Facilities
Customized Services - Our clinically trained staff has years of clinical and consulting experience. We customize our services based on your needs.
Let us work with your staff to identify issues, fine-tune procedures and provide ongoing support! For more information call 281.364.1156 or complete the information on page 2.