Physician
Reimbursement Improvement Services
LEVELS OF SERVICE
UTILIZATION (E & M CODING)
·
Comprehensive comparison of
practice utilization of major evaluation and managment codes against HCFA
Standards in order to determine audit liability exposure and reimbursement
improvement potential.
FEE SCHEDULE ANALYSIS
·
Comparison of usual and customary
charges against appropriate percentile of charges in practice's primary service
area in order to determine opportunities for fee schedule adjustments.
MANAGED CARE CONTRACT
ANALYSIS/EVALUATION
·
Thorough review of existing managed
care contracts and prospective contracts by in-house legal counsel as well as
comparison of charge/collection ratios of all major third party payors.
(800) CODING HOTLINE
·
Access to PPP, LLC Reimbursement
Specialist via telephone or facsimile consultation by calling 1-800-764-2633.
CODING COMPLIANCE PROGRAM
·
Comprehensive review of
reimbursement systems in order to determine audit liability, reimbursement
opportunity and/or missed billings. This process involves medical record
(chart) audits, ongoing coding education and the development of benchmarks for
ongoing compliance. Serves as basis for reimbursement system component of
medical practice compliance management plan.
DOCUMENTATION GUIDELINES
COMPLIANCE
·
Chart auditing services involving
compliance with Medicare documentation guidelines and summary checklists for
use by practice to ensure compliance.
CPT-4 FREQUENCY REVIEW
·
Review of utilization of major
CPT-4 procedural codes to determine practice opportunity based upon individual
specialty.
ICD-9 FREQUENCY REVIEW
·
Review of utilization of ICD-9-CM
diagnostic codes to determine practice opportunity based upon individual
specialty.
CODING VALIDATION/LOGIC
LINKING (ICD-9/CPT/HCPCS) DOCUMENTATION
·
Medical necessity review targeted
to improving opportunities as well as meeting compliance standards.
CUSTOMIZED TRAINING
PROGRAMS
·
See our Educational Offerings
VALIDATE
SUPERBILL/ENCOUNTER FORM FOR ADDITIONS/DELETIONS (2000 CODE CHANGES)