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Physician Coding

Perform a prospective or retrospective review of a sample of claims and supporting documentation to evaluate complete charge capture and documentary support for claimed services, assuring optimum revenue and prevention of overpayment. This review can be a general review, service-specific and/or site specific.

Compliance and training in the area of E&M Services; National E&M Educator for the AMA.

Medical & Surgical Specialty Practices are served by clinicians and/or coders with experience in the specialty area(s) involved. These reviews are additionally focused on maximizing compliant "consult" billing.

Physician Practices providing on-site Laboratory, Radiology and/or Diagnostic Services can include a review of compliance in these areas as an add-on or stand alone engagement. This includes evaluating compliance with Medicare regulations governing "supervision" of diagnostic tests

An in-depth CLIA Review is available for Physician Practices with more complex on-site laboratories

Physician Practices providing Interventional Radiology or Radiation Oncology services are served by clinicians and/or coders with experience in these areas. (See also Radiology Compliance page)

Physician Practices providing services via Advance Practice Professionals (NP's, CNS's, CNM's, CRNA's, PA's, Chiropractors, Podiatrists, Optometrists Dieticians, Diabetes Educators, Licensed Social Workers, Psychologists, etc) can include a compliance review in this area as an add-on or stand alone engagement

Revenue Optimization reviews are available as an add-on or stand alone engagement, to identify areas of missed revenue; focusing on revenue maximizing via complete charge capture, inclusion of add-on services, proper modifier utilization, use of documentation templates and appropriate ancillary staff utilization in provision of patient services.

"Incident-to" and "Direct Billing" compliance reviews

Diagnosis Coding is standard to all reviews; a focused review on diagnosis coding compliance and revenue optimization is available as an add-on or stand alone engagement.

Physician Practices providing services to End Stage Renal Disease patients can have a compliance review with regulations governing these services as an add-on or stand alone engagement.

Physician Practices providing Preventive Care and Screening Services can have a compliance review in these areas included in a standard engagement or purchase an expanded review as an add-on service

Physician Practices providing care to patients involving Skilled Nursing Facilities, Home Health Agencies or Hospices, including the Certification/Re-Certification for services, compliance review within these areas is available as an add-on or stand alone engagement.

Physician Practices providing Pediatric or Psychiatric/Mental Health services have compliance reviews performed by clinicians and/or coders with experience in these areas. This includes available review of Psychologist services.

Medicare's ABN regulation compliance reviews are available as an add-on or stand alone engagement.

Claim Denial, Suspend and Reduction reviews are available; including preparing Re-submissions and preparing/supporting Payer Appeals.

Litigation Support in Administrative Hearings, Fraud/Abuse Actions & Settlement Negotiations

HIPAA compliance reviews

Stark Law compliance reviews

PATH compliance reviews for Academic Physician Practices

Seminars and Training services in all physician compliance areas for both clinical and non-clinical staff.

Seminars and Training sessions on compliance within the clinical research arena are available for both clinical and non-clinical staff.

Billing Seminars on physician services

Coding: Per diem and "backlog" coding services by AAPC certified coders