Outpatient PPS Compliance Services
Perform a prospective or retrospective review of a sample of Institutional outpatient claims and the corresponding medical record documentation to assure complete charge capture, accurate coding and documentary support for claimed services. This includes a focus on both revenue optimization and compliance with PPS requirements to avoid overpayment.
Perform a review for accurate capture of "Pass-Through" services, other additionally billable services and appropriate modifier utilization, assuring maximal revenue.
Perform a review for compliance with "Outlier Payment" requirements
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 is available with a 24 hour response time in most cases.
Documentation & Charge Capture Templates
Claim Denial, Suspend and Reduction review to assess problem areas and identify solutions as well as preparation of Re-submissions & Payer Appeals.
"Shadow Review" service for Third Party Payer "Medical Claim Review" is available as an add-on or stand alone engagement.
Litigation Support in Medicare
fraud/abuse actions
.
Seminars for
clinical and coding staff on coding & documentation for outpatient
PPS services.
Billing seminars on outpatient PPS services.
"Update Seminars" focusing on regulatory change
All seminars are available on videotape
Additional services available