Medical Coding Assistance
Protection Against Submitting False or Inaccurate Claims
Consolidated MD performs claims reviews by Clinician Auditors and/or Medical Coding Specialists to identify potential problems with physician billing documentation and coding accuracy. Due to the complexity of current charging systems, documentation and billing errors are common and have a wide variation from facility to facility. It is critical to have a Clinician Auditor and/or a Medical Coding Specialist who is specifically trained to identify and handle these documentation errors so as to avoid inadvertent fraud penalties and to receive reimbursement on all filed medical claims.
Accurate, Compliant, and Appropriate Payments
The primary objective of Consolidated MD’s coding review, education, and assistance service is to ensure that services were ordered by a physician and provided to the patient according to medical billing protocol, documented in the medical record, and billed correctly. Fraud reviews are only becoming more and more prevalent in the medical industry and your practice needs a dedicated Medical Coding Specialist there to review, monitor, and implement the necessary changes to your medical claims when they are filed.
Inpatient Coding and DRG Reviews
Consolidated MD’s coding review program consists of verifying the accuracy of the codes assigned and validating that the documentation supports them. We feel that education is an extremely important aspect of this review and work to educate both the coder and the physician as requested. The use of actual data from your site makes the education more focused and valuable to your staff. We support our suggestions with Official Coding Guidelines and Coding Clinic back up.
Outpatient Coding and APC Reviews
This program can be all inclusive of areas in your facility that are impacted by APC payments. Your practice criteria are adhered to in the determination of levels of care, in Clinics and Emergency Department reviews. We review the correct usage of Modifiers to ensure that proper reimbursement is recovered by your facility, and Medical Necessity is reviewed to be sure payments will not be denied. As with all coding reviews that Consolidated MD performs, education is included in the review. CPT and ICD-9 coding suggestions are supported by Official Coding Guidelines.
Avoid Medicare Outlier Payment Problems
Consolidated MD utilizes a progressive compliance strategy to ensure that billing for Medicare payments regarding outliers and services is appropriate. Our strategy is designed to ensure the greatest level of scrutiny to help identify potential problems. We will perform a line item review of patient records to determine if care is reasonable and necessary. Our specialists address documentation issues and charging in the light of official Federal, State, institutional guidelines, and OIG alerts.
Physician Billing Reviews
Consolidated MD consultants review billing and supporting documentation submitted on behalf of Physicians to determine if the correct Evaluation and Management Procedure Codes are submitted on the services performed. Documentation to support and protect the Physician billing is of the utmost importance to any Physician Practice Plan, Physician Group of Individual billing for their services. This review includes proper diagnosis code assignment for Medical Necessity of services, E&M or procedure coding and Modifier application that will ensure that the practices stay compliant with their billing practices. Education is a large part of this process for the Physicians and Coding Staff, and is enhanced by using actual data extracted from their reviews.
Consulting Services Include
Correct Use of Modifiers
We will review & research, if needed, the correct use of modifiers for your individual claim or claims.
ICD9, ICD10 & CPT Coding Assistance
Learn how to properly utilize all ICD9 & ICD10 codes to get your office or client full reimbursement. Can’t find the correct code? Let us help you find the code you need, including the hard to find codes needed to get your claim(s) paid in full the first time.
Denied Claims Appeal
Proper documentation of appeal letters & the steps needed to acquire the revenue due to you following an insurance denial.
Physician Credentialing Assistance
Assistance with the proper use of the needed forms & the required letters of intent. Consolidated MD’s physician credentialing staff can also perform these services for you and much more….
Medical Coding Interaction
Assistance with what codes can be billed together and what codes can not used in conjunction with others.
HCPCS Coding Assistance
Learn how to properly utilize all HCPCS codes to get your office or client full reimbursement. Can’t find the correct code? Let us help you find the code you need, including the hard to find codes needed to get your claim paid in full the first time.
Correct Use of the CMS 1500
Need help filling the claim form? Learn how to correctly fill out this claim form to get reimbursed in full the first time.
Individual Claims Assistance
Assistance resolving those difficult claim issues.