Ambulatory coding/billing/APC compliance reviews are performed, on-site, to validate ICD-9/CPT/HCPCS/revenue coding of services provided per the medical chart and asses the quality of the chart documentation. These reviews are performed upon an appropriate sample of patient encounters in the Emergency Room (ER), Ambulatory Surgery (AS) and Diagnostic Services. The reviews also verify that CPT/HCPCS codes of services per the chart have been recorded on UB-92 with correctly assigned revenue codes. For the ER and/or the clinic encounters, the appropriateness of the Evaluation and Management (E&M) service levels relative to the care provided per the chart, are assessed. All significant coding changes are flagged and documented. St Clair will conduct an exit conference, regarding preliminary review findings and recommendations. St Clair will also do an educational in-service discussion with HIM coders on "coding/change documentation" findings. This discussion qualifies for one (1) continuing education (CE) credit under CE requirements of AHIMA. A final report will be provided within two (2) weeks of the exit conference.
Benefits
This review will asses your compliance with the National Correct Coding Initiative (NCCI) edit standards and the CMS regulatory standards. This review enhances hospital efforts, through the educational process, to optimize ambulatory reimbursement. For one (1) year after the review, at no additional fee, St Clair provides consultant support, via telephone and/or email, to address any questions about the final report and/or inpatient coding regulatory changes.
Pricing Approach
The St Clair professional fee for an on-site ambulatory coding/APC review is competitively priced on a "per-record" reviewed basis, plus out of pocket travel expenses.