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Radiology Services

Perform a prospective or retrospective review of a sample of radiology claims to determine compliance with Medicare and Third Party Payer regulations governing radiology 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 orders and accurate reporting of POS, if applicable, assuring optimal reimbursement. The review also includes a focus on diagnosis coding by radiology 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

Areas available for review include:

·MRI

·MRA

·CT

·PET

·Bone Density

·Ultrasound

·Echocardiography

·Nuclear medicine

·Fluoroscopy

·Diagnostic vs. Screening services

·Pre-operative services

·Portable/Mobile radiology services

·Ob/GYN/Fertility services

·Contrast Media

·Radiopharmaceuticals

·Interpretation issues

Review of any Policy & Procedure Manuals is available as an add-on or stand alone engagement.

In academic radiology departments/practices where PATH Regulations apply, an additional review of compliance in this area is available

In radiology departments/practices where Interventional Radiology is practiced, reviews are conducted by clinicians and/or coders with expertise in this highly complex areas. The reviews include a focus on the use of consults in this specialized area of radiology, complete charge capture for optimal revenue (catheterization/injection/contrast/supervision & interpretation) documentary support for claimed services, diagnosis to support medical necessity and includes all 5 interventional areas of specialty:

·Arterial

·Venous

·Pulmonary

·Portal

·Lymphatic

In radiology departments/practices where Radiation Oncology is practiced, reviews are conducted by clinicians and/or coders with expertise in this highly complex area. The reviews include the following areas of high risk:

Consultation services within the radiation oncology specialty; in particular continuing and special physics consultations

History & Examination documentation

Time based coding & documentation of visits

Treatment Plan requirements, coding criteria (simple/intermediate/complex), documentation, bundled services and frequency limits

Simulation requirements, coding criteria (simple/intermediate/complex/3-dimensional), documentation, frequency limits, calendar date limits, bundling services and modifier utilization

Radiation Therapy Management coding criteria (fractions, stereotactic radiation, special treatment procedures), bundled services, documentation and frequency limitations

Dosimetry Calculations coding criteria (calculations/re-calculations, special calculations), documentation, frequency limitations and bundled services

Brachytherapy coding criteria: infusion, intracavity application (simple/intermediate/complex), interstitial application (simple/intermediate/complex), remote afterloading (number catheters),surface applications, supervision/handling/loading radiation source;

Hyperthermia coding criteria: external (superficial/deep), interstitial (# applicators), intracavity; documentation, bundled services and frequency limitations

Diagnosis Coding to support medical necessity

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.

In radiology departments/practices utilizing Electronic Medical Records and/or Electronic Signatures, compliance review 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 as well as preparation of Re-submissions and Payer Appeals

Litigation Support in Medicare fraud/abuse actions

HIPAA compliance reviews

Stark Law compliance reviews

Compliance Plan design, implementation & training; focus is on the OIG’s Model Compliance Plans

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.

Documentation and Charge Capture Templates

Seminars in all areas detailed above are available for clinical and non-clinical staff

Billing seminars on radiology services

Update Seminars are available; focusing on regulatory change

All seminars are available on videotape