Specialized Services for Medical Practices—Revenue Assurity
Periodic Practice assessment is a necessary, critical component in determining a medical practice’s health and efficiency. If personnel in your Practice aren’t coding services properly, the outcome can be significant income loss and increased compliance risk. A robust procedural and diagnostic analysis of coding practices affords an organization the opportunity to identify irregularities that exponentially increases income, and decreases compliance risk.
Like peeling the layers of an onion, Kohler HealthCare Consulting (KHC) uncovers the fiscal, operational, and compliance strengths and weaknesses of revenue creation impacting your organization’s bottom line and risk profile.
Unique and complex compliance issues KHC addresses include:
- Understanding Medicare differences among payers
- Establishing uniformity when using CPT and HCPCS codes
- Clarifying regulations regarding non-physician providers, shared visits, teaching regulations and use of ‘incident to’
- Resolving conflicting answers from facility and professional providers
Our client results are achieved by focusing on three (3) targeted procedures: Baseline Audits; Provider Documentation, Coding and Billing Reviews; and Compliance Training.
Our approach to baseline audits is streamlined, yet comprehensive. KHC conducts a baseline audit that evaluates current documentation and coding practices. We use a pre-determined number of encounters per physician/provider to summarize results for comparative purposes. Based on our review, we can prepare a Bell Curve analysis that compares our findings to national benchmark data. This approach, along with our specialized reporting tool, provides compliance rating results for each physician, and helps each provider understand the components that need to be addressed to enhance revenue and ensure compliance.
In addition, prior audits are evaluated to determine whether: (a) the right conclusions were reached; (b) the providers understood the results; and (c) changes have been implemented in response to the reviews. KHC’s baseline audits are a holistic evaluation of the current state of a Practice, and the first step in our process of helping a Practice attain fiscal and compliance good health.
Providers consistently call upon KHC to provide detailed training to their staff, hospitals and medical groups because of our expertise gained working with professional fee practices. In addition, we are often hired to educate physicians and facilitate the development of compliance programs to ensure accurate and timely coding of professional services.
Rather than taking the stance that “the CPT code says so,” we work with providers and their staffs to understand the nuances of coding. This approach results in recommendations that make sense to those involved in coding because they are based on the clinical services provided, and incorporate the various rules governing a multitude of payers.
Whether you need an expert witness for litigation against a provider, a one-on-one informational session, or someone to function as an Independent Review Organization, look to KHC for definitive and supportable assistance.
- Independent Review Organization (IRO)
- Independent Compliance Coding
- Education and Training
- Resolution of Regulatory Issues
- Documentation of Services Provided
Approach to Improvements
The philosophical approach toward compliance and operations involves evaluating the details while understanding the global problems and implementing guidance and useful tools that empower our providers to succeed.
Provider Documentation, Coding and Billing Reviews
Standardization is important part of the framework of our professional and personal lives. However, trying to create standardized processes without a thorough understanding of current strengths, challenges and gaps won’t create sustainable and desired results.
KHC professionals have extensive knowledge of physician, hospital and other provider billing systems. We’ve performed detailed reviews of UB-04 and CMS-1500 billing forms, analyzed the processes and procedures utilized by providers to prepare the forms for submittal to payers for reimbursement, and performed careful reviews of internal controls, policies, and procedures used by providers to ensure claims are prepared accurately and in accordance with the laws governing the healthcare industry.
These audits are conducted by certified KHC coders, who diligently identify opportunities for improvement, and provide educational support to ensure accuracy and improvement of documentation standards overall.
Our approach offers solutions that address policy and procedure review, the query process, incomplete record management, coding quality reviews and compliance with Federal healthcare guidelines. More importantly, our results offer information a Practice can use to assess its strengths and weaknesses, and develop a plan for improvement.
The final, and perhaps most important step in our process, is compliance training. KHC utilizes proven, successful compliance plan models to develop a customized program for you. We identify and discuss specific concerns regarding your current compliance plan activity, and structure a program that is unique to your needs and goals.
Audit review findings can be incorporated into a broad follow-up coding requirements training session for providers. Audit results offer actual examples of the providers’ own coding and documentation practices, which are far more meaningful and relevant to your staff from a training perspective. These examples also provide a baseline for the Practice, and define opportunities for improvement. Ongoing audits can be conducted for physicians and providers not meeting compliance goals, and customized training modules specific to each physician can be developed for more focused training.
KHC’s revenue assurity and compliance “check-up” puts the pieces together and gives you confidence that your Practice is healthy, efficient and compliant.