Physician Compliance
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
Our Coding Helpline to answer
coding/billing questions is available with a 24 hour response time in most
cases
"Charge Capture" & “Documentation” Templates
Physician Practices involved in Clinical
Trials can have FDA compliance reviews
performed as an add-on or stand alone engagement..(See
also FDA/ICH Compliance Services page).
Physician Practices providing services to Medicare Patients Enrolled
in Outside Clinical Trials can have compliance
reviews performed for regulations governing these beneficiaries and
reimbursable services
All seminars are available on videotape
Additional services available