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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 ·
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 |