Back

Ambulance Coding

Perform a prospective or retrospective review of a sample of ambulance claims to evaluate compliance with Medicare regulations governing ambulance reimbursement, Medicaid regulations regarding transportation reimbursement and additional Third Party Payer regulations governing these services on a client requested, Payer-specific basis. Review includes an audit of documentary support for services claimed. Focus is on revenue optimization yet prevention of overpayment. High risk key areas included are:

• Qualifying Patient Condition(s) and documentary support for such
• Qualifying vehicle under applicable regulatory definition and documentary support for such
• Qualifying Staff under applicable regulatory requirements and documentary support for such (including BLS/ALS)
• Medical Necessity and documentary support for such
• Audit of compliance with regulations governing "Attended Transport" and documentary support for such
• Audit of Time Coding, Billing & Documentation
• Revenue Optimization review of complete and accurate capture of additionally billable, non-bundled services, "POS" Differential reimbursement and appropriate utilization of CCI Critical Care Transport Edits
• Prevention of overpayment through review to assure complete "Bundling" of services
• Review of compliance with Certification Requirements and documentary support for such (including "48 Hour Rule")

If significant Critical Care Air Transport and/or Neonatal/Pediatric services are provided, reviews will be performed by clinicians and/or coders with expertise in these areas

If significant Scheduled Transport services are provided, an additional review in this area is available as an add-on or stand alone engagement

If significant ESRD transport services are provided, an additional review in this area is available as an add-on or stand alone engagement

While a review of accurate and complete Diagnosis Coding is standard to all reviews, a focused review on diagnosis coding is available as an add-on or stand alone engagement.

Coding: “per diem” and "backlog" coding services are available by AAPC certified coders

Our Coding Helpline to answer coding/billing questions on demand is available with a 24 hour response time in most cases.

“Charge Capture” and “Documentation” Templates

Physician Practices utilizing Electronic Medical Records and/or Electronic Signatures, compliance reviews in these areas is available as an add-on or stand alone engagement

A "Shadow Review” service for Third Party Payer "Medical Claim Reviews" is available as an add-on or stand alone engagement.

Claim Denial, Suspend and Reduction reviews are available to identify problem areas and solutions; including preparing Re-submissions and Appeals.

Litigation Support in Medicare fraud/abuse actions

HIPAA compliance reviews.

Reviews to determine compliance with Medicare's ABN regulations is available as add-on or stand alone engagements

Stark Law compliance reviews

Corporate Compliance Plan design, implementation & training; focus is on the OIG's “Model Compliance Plans”

Seminars in compliance, coding and documentation are available for both clinical & non-clinical staff

Billing seminars for ambulance/transportation services

"Update Seminars" are available; focusing on regulatory change

All seminars are available on videotape.

Additional services available