Interventional Radiology

Revenue Enhancement And

Compliance Reviews

 

 

A Special Portfolio of Services For

ER Compliance & Revenue Enhancement

 

Developed & Provided By

The Consultants At:

 

Abbey & Abbey, Consultants, Inc.

 

Ames, Iowa

 

A Member Of:

 

The HealthCare Consulting Group, L.C.

Contact Information:

 

Telephone: 1-515-232-6420                       e-mail:  Duane@aaciweb.com

FAX: 1-515-232-7496                      Internet:  http://www.aaciweb.com

 

 


 

Interventional Radiology - Revenue Enhancement & Compliance Review Services

 

Interventional radiology is a rapidly expanding hospital service area.  Expansion is occurring through the volume of services, increasing technological sophistication and a wider range of services.  The rapid expansion of services creates gaps in hospitals ability to properly code, bill and be appropriately reimbursed for these special services.  Medicare’s implementation of APCs (Ambulatory Payment Classifications) implementation of various APG (Ambulatory Patient Groups) type payment systems and a host of other payment mechanisms further complicates the coding and billing process.

 

Interventional radiology includes special areas such as:

 

·        Surgical Interventional Radiology

·        Cardiac Catheterization Laboratory (Cath Lab)

·        Vascular Laboratory

·        Intracardiac Electrophysiological Procedures (EP Lab)

 

These special interventional radiology services should be major profit centers for hospitals.  However, these areas represent major challenges for coding, billing and assuring compliance.  Through careful structuring, organization, proper coding, good documentation, up-to-date fee schedules and a properly organized Charge Masters hospitals can improve:

 

Ø     The Quality Of Care Through Proper Procedural Flow

Ø     Improve Outcomes And Patient Satisfaction

Ø     The Quality And Appropriateness Of Documentation

Ø     Coding, Billing And Reimbursement

Ø     Appropriateness Of Physician Fees And Hospital Charges

Ø     Compliance Adherence To Coding and Billing Rules

Ø     Reimbursement Under APCs, APGs and Other Payment Systems

 

Using an Integrated Approach to the IR Challenge

 

The trick for addressing both revenue enhancement and compliance conformance for Interventional Radiology is to bring expertise together from several different areas.  The following areas must be considered individually and also integrated as a whole.

 

1.   IR Physicians Coding – Radiology, Surgery & E/M

2.   IR Physicians Fee Structuring – RBRVS – Radiology & Surgery

3.   IR Physicians Documentation Process & Compliance Standards

4.   IR Physicians Charging Process

5.   IR Physicians Claims Filing & Processing – CMS-1500

6.   Facilities Coding – Radiology, Surgical & E/M - Modifiers

7.   Charge Master Development - Facilities - Supplies - Drugs

8.   Charge Master Compliance Standards

9.   Charge Master Charge Structuring & Charge Algorithms

10. Facilities Coding – Charge Master Versus Coding Staff

11. Interfaces – Recovery - Observation - Inpatient

12. Organizational Structuring & Physician-Hospital Interfaces

 

Add to this list other clinical concerns such as outcomes management, expensive technology, and patient satisfaction along with general concerns of efficiency and effectiveness, and it is little wonder that the rapidly growing Interventional Radiology area presents a complex opportunity for both physicians and hospitals.

 

In order for hospitals to meet the twin goals of:

 

·        Being Properly Paid (Revenue Enhancement), and

·        Being In Compliance (Compliance Adherence);

 

require a combination of skills, abilities and characteristics on the part of hospitals.


 

Interventional Radiology Revenue Enhancement & Compliance Review

 

The process of improving revenue generation while maintaining compliance varies according to the size and type of a give hospital and/or system of hospitals.  The following provides a generic outline of the necessary activities to meet revenue enhancement and compliance goals.

 

Tasks and Activities

 

The activities involved in addressing both revenue enhancement and compliance involve:

 

·        Review of the radiology and associated surgical/medical procedure sections of the Charge Master including ancillary areas directly involved with interventional radiology services,

·        A review of the overall interventional radiology services, documentation, coding, claims filing and reimbursement process,

·        Review current coding/billing policies and procedures,

·        Review of the organizational structure involving the IR including both formal and informal arrangements including use of non-physician providers,

·        A review compliance for both service provision, coding, billing and professional versus technical code correlation,

·        On-going training activities for coding, billing and IR staff personnel,

·        Establishment of an organizational infrastructure to address interventional radiology coding, billing and compliance issues.

 

Typical consulting activities and steps are outlined below.

 

   Prior to On-Site Visit

         

1.     Review of the Charge Master sections for radiology, catheterization laboratory, vascular laboratory, and EP services along with identification of any problem areas with coding, charges, modifiers, etc.

2.     Review coding/billing policies and procedures in the IR areas.

3.     Review of order entry, encounter forms, charge sheets and other mechanisms for coding and charge input.

4.     Review the service-coding-billing process flow.

 

   On-Site Visit

 

5.     Meeting with Revenue Enhancement Team (Business Office, Finance, HIM, IS, and IR service personnel) concerning overall process, objectives and schedule of activities.

6.     Review of how the Charge Master entries are being used, encounter form utilization, computer system capabilities and any associated flow problem areas.

7.     An audit of a sample of cases (claims, detailed statement and documentation) is performed for each IR area.  This includes:

a.     Review of documentation,

b.     Review for proper code development for both physician and facilities coding including compliance concerns (e.g. correlation of physician and hospital coding).

c.     Checking for proper reimbursement and any associated problems (e.g. CMS’s Correct Coding Initiative denials).

d.     Review the Charge Master and computer system interfaces relative to static and dynamic coding and proper generation of UB-92s and CMS-1500s.

8.     Study and assessment of the organizational structure for the IR service areas including any ‘under arrangement’ situations.

9.     Meeting with charge master personnel relative to recommended changes in the Charge Master.

10. Meeting with HIM coding personnel relative to coding problems and associated documentation concerns.

11. Meeting with IR staff relative to compliance implementation,

12. Meeting with the Revenue Enhancement Team to discuss findings of the on-site assessment.

13. Meeting with the IR physicians as appropriate to discuss any recommendations relative to their activities and to discuss any possible compliance concerns.

14. Training session(s) for IR coding, billing and IR service area personnel relative to the documentation, billing, coding, and reimbursement process.

 

After Visit Activities

 

17.  Preparation of final report concerning the assessment and recommendations relative to coding, Charge Master, documentation, APC/APG utilization and possible compliance concerns.

 

On-Going Review Activities

 

18. Quarterly review and training sessions are provided to continue the process of revenue enhancement and proper compliance.

19. On-going support services through e-mail, FAX and/or telephone conference calls are also available.

 

 

Deliverables

 

The deliverables fall into two categories:

 

1.     Discussions and guidance during the on-site visit,

2.     Education and training session(s),

3.     Final report detailing findings and making recommendations for changes,

4.     On-going support services.

 

Benefits

 

The benefits involve:

 

1.     Increased revenues from IR activities, and

2.     Decreased compliance exposure.

 

Additionally, the final report will address any changes that need to be considered for optimization of revenues under various outpatient payment systems.

 

Costs/Investment

 

Costs for the services must be developed after a specific program of services has been established.

 

 

Distinguishing Characteristics of Abbey & Abbey, Consultants, Inc.

 

 

1.     Our activities are highly educationally oriented.  Almost all studies involve special training for those participating in the process.

2.     One of our goals is to provide our clients with the infrastructure and resources to be independent for ongoing maintenance activities so that continuing consultation is generally not necessary.

3.     All of our services in the Charge Master and Revenue Enhancement areas include careful consideration of compliance issues.

4.     We will also review and address APC/APG issues both for the current implementations and future implementations.

5.     Consideration will also be given to any organizational structuring that can enhance current revenues and/or future payment systems.

6.     Access to a wide range of consultative and legal expertise in the health care field through our membership in the Health Care Consulting Group, L.C.

 

Contact Information

 

Duane C. Abbey, Ph.D., CFP

Abbey & Abbey, Consultants, Inc.

P.O. Box 2330

Ames, IA 50010-2330

TEL=515-232-6420       e-mail: Duane@aaciweb.com

FAX=515-232-7496       WWW: http://www.aaciweb.com