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Understanding that accurate, proper and complete ICD-9-CM
and CPT procedural coding can significantly impact a facility's compliance
initiatives and revenue stream, The Rybar Group has compiled a team of
skilled, credentialed consultants that are dedicated to working with you
in meeting the needs of your facility. Our consultants are available to
provide you with a full array of inpatient, outpatient, and special auditing
and educational services. Focus areas include:
Click a topic to go to that section:
Charge
and Description Master Review and Quality Assurance
(top of page)
As your facility’s “information aorta”,
an updated Charge and Description Master is critical to adhering to billing
compliance requirements and to receiving accurate reimbursement. An out-of-date,
incomplete, and inaccurate CDM can result in decreased, missed, or delayed
facility reimbursement.
Our Charge and Description Master Review provides monitoring of HCPCS coding for accuracy of third-party payor compliance, and accurate billing for outpatient services. Our consultants will review and analyze your Charge and Description Master for accuracy of HCPCS coding, appropriate use of UB-92 revenue codes, charges below the APC or fee screens, and opportunities to obtain accurate payments. Standard to our review is the performance of Quality Assurance to ensure that the services performed are those that are billed.
A complete chargemaster review includes all departments; however, specific departments may be targeted based upon the needs and priorities of the facility. Examples of Specialty Departments available for individual review are:
- Laboratory
- Tissue Pathology and Cytology
- Medical Imaging/Interventional Procedures
- Cardiac Catheterization
- Cardiology/Cardio-Pulmonary
- Rehabilitation (Including Physical, Speech, Occupational, Cardiac, and Pulmonary)
- Ambulatory Surgery
- Emergency Room
- Chemotherapy
- Clinics (i.e., Pain, Wound)
- Pharmacy
- Surgery Supplies
- Sleep Studies/Neurology
Coding,
Billing, and Documentation Quality Assurance Review
(top of page)
One key component of a compliance plan is auditing and monitoring. Let
the Rybar Group’s Quality Assurance Review do the work for you. Designed
to evaluate the overall effectiveness and accuracy of your Hospital’s
coding in various service areas, this engagement provides an analysis
for validating revenues.
A complete review, including both facility and physician services, may be performed. Specific review areas may be targeted. Areas of focus may include:
- Laboratory
- Tissue Pathology and Cytology
- Medical Imaging/Interventional Procedures
- Cardiac Catheterization
- Cardiology/Cardio-Pulmonary
- Rehabilitation (Including Physical, Speech, Occupational, Cardiac, and Pulmonary)
- Ambulatory Surgery
- Emergency Room
- Chemotherapy
- Observation Services
- Clinics (i.e., Pain, Wound)
- Pharmacy
- Sleep Studies/Neurology
Accurate procedure coding along with proper documentation and a valid physician order can assure appropriate reimbursement and allow consistency and compliance with third-party payor regulations and coding conventions.
ICD-9-CM
Coding Quality Assurance (top
of page)
Precision and accuracy in ICD-9-CM diagnosis and procedure coding ensures
appropriate DRG assignment and accurate reimbursement. Our thorough analysis
of DRG-based discharges can identify trends in documentation and coding
deficiencies before they become an issue.
Documentation
Programs (top
of page)
Our experienced consultants will analyze the clinical documentation processes
of your facility to ensure that the medical treatment being afforded to
your patients is recorded accurately. We shall assist the Hospital in
identifying potential areas of opportunity and educate both Hospital and
physician staff on enhancements that will improve data quality and provide
for appropriate case mix reimbursement.
Inpatient
Documentation Assistance (top
of page)
The Inpatient Documentation Assistance program is designed to enhance
documentation and provide high levels of Medical Record data quality.
Better documentation increases your opportunities for coding more intensive
patient treatment, and can result in a higher weighted case mix index.
This program provides education for nursing, medical staff, medical records,
and case management. The education that is provided is important to promote
documentation that supports coding and case mix accuracy.
Case
Mix Index (top
of page)
Appropriate coding and documentation has a direct effect on your case
mix index (CMI). We will perform a review of your yearly CMI data, working
to identify potential opportunities for improvement. The results of the
analysis will be improved reimbursement for the Hospital.
Observation
Services
(top
of page)
The Rybar Group consultants specialize in managing coding, documentation,
and utilization management issues involved in observation services.
A review for all payors will be performed to determine if any of the Hospital’s observation patients had medical conditions that met the SI/IS criteria for admission and could have been admitted as inpatients. Cases will also be reviewed to determine if they met criteria for admission to observation and if they were true observation cases, that they were documented, coded and billed appropriately.
Educational services (physician and/or facility) relating to observation are also available.
ABN
Process and LMRP Review
(top
of page)
ABNs and LMRPs are key elements to a successful revenue cycle and to corporate
compliance. Our consultants will work to review your facility’s current
operations and will make recommendations. Our goal is to help you improve
work processes and enhance workflow in Patient Accounting due to rejections
relating to ABN issues.
HIM
Operation Analysis
(top
of page)
The Operation Analysis program is designed to review and analyze the current
Health Information Management Department operations and work processes.
Our approach will identify opportunities for streamlining, improving workflow,
productivity, quality-control procedures, and eliminating unnecessary
tasks.
Simulated
Blue Cross High Dollar Audits/Appeals (top
of page)
(Michigan Hospitals only)
Pre-High
Dollar Audits
The Rybar Group has designed an audit to be performed prior to your actual
High Dollar Audit by BCBSM. This simulated audit will assist in identifying
potential issues in the ordering, charging, and documentation process
for BCBSM outpatient services.
High
Dollar Audit Appeals
The Rybar Group understands that the results of a High Dollar Audit can
be costly, and that the appeal process can be challenging. Our consultants
have worked with several Hospitals throughout Michigan on such appeals.
Our appeal program offers several benefits to the Hospital, including a review of your compliance with BCBSM regulations, assurance of appropriate reimbursement, and a financial savings, as less money will be paid out due to costly audit findings.
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& Critical Access Hospitals • Management
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Volume Adjustment • Career Opportunities
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