Back

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

·        Teletherapy Isodose Plans coding criteria (simple/intermediate/complex, “special” plans),  brachytherapy isodose plan (simple/intermediate/complex), documentation, frequency limitations and “bundled” services

·        Treatment Devices coding criteria (simple/intermediate/complex,), documentation, frequency limitations and  “bundled” services

·        Radiation Treatment Delivery coding criteria (energy levels/treatment areas/ports/blocks/hyperfractionalization/multiple treatment sessions), documentation, “detail line” billing and “bundled” services.

·        Proton Beam Therapy Delivery coding criteria (single/simple/intermediate/complex), professional vs. technical components; documentation 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