Laboratory Coding
Perform a prospective or retrospective review of a sample of laboratory claims to determine compliance with Medicare and Third Party Payer regulations governing laboratory services. This includes a review to assure accurate coding, CPT, HCPCS and ICD-9, complete charge capture, appropriate bundling of services, documentary support for services claimed, including physician order and performance of testing within the laboratory’s CLIA certification. It also includes review to assure accurate reporting of POS necessary for optimal reimbursement. The review also includes a focus on diagnosis coding by laboratory personnel when narrative diagnoses alone are submitted with physician orders.
A review of compliance with Medicare’s ABN requirements is a part of this engagement as is review of any charge capture document(s)/requisitions utilized.
Review of a laboratory’s Policy & Procedure Manuals is available as an add-on or stand alone engagement. This includes a review of compliance in high risk areas including:
oral orders
add-on orders
custom profiles
standing orders
automated panels/medical necessity
Medicare’s 72 hour rule
supplies provision to physician offices and/or hospitals
record retention
blood borne pathogen program
RIA testing
West Nile Virus
70% on site test run/shell lab issues
drug screening
pathology services
pap smears
screening tests
reference lab/ referral lab issue
specimen collection home/SNF
Medicare’s physician supervision issues
purchased interpretation issues
hazardous waste
A CLIA compliance review, including QC Regulations & Inspections, is available as an add-on or stand alone engagement.
In laboratories performing RIA Testing, a review for compliance with NRC regulations is available as an add-on or stand alone engagement
Documentation and Charge Capture Templates
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.
Compliance Plan design, implementation & training; focus is on the OIG’s Model Compliance Plan for Clinical Laboratories
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 as well as preparation of Re-submissions and Payer Appeals
HIPAA compliance reviews
Litigation Support in Medicare fraud/abuse actions
Stark Law compliance reviews are
Seminars on coding, documentation and billing laboratory services are available for both clinical and non-clinical staff
Billing seminars on Laboratory services
CLIA seminars for clinical and non-clinical staff
Update Seminars are available; focusing on regulatory change
All seminars are available on videotape
Additional services available