Medical Coding Regulatory Compliance Services. For hospitals, physician practices and other providers, two objectives matter most when it comes to billing for clinical services maximizing revenues and reducing regulatory risk. Faced with an increasingly complex regulatory environment and aggressive federal and state audit initiatives, medical billing and coding operations at hospitals and physician practices must comply with all applicable healthcare laws and regulations. Additionally, lost revenue from poor medical coding practices can significantly impact financial performance. And now with ICD 1. The solution is a full time, hands on medical coding and regulatory compliance program. AAPCC Adjusted Average Per Capita Cost. The basis for Health Maintenance Organization HMO or Competitive Medical Plan CMP reimbursement under Medicarerisk. Medical Coding, Billing and Compliance Services for Healthcare Providers Capture all revenue opportunities, maximize reimbursement and comply with all billing. Medical Necessity. The Centers for Medicare Medicaid Services CMS set a standard for coverage which commercial payers may not follow. Per MLN Matters article. We are pleased to share the preliminary agenda for PointClickCare SUMMIT 2017. Check back often as more sessions and information will be added over the coming weeks. The program should include both the review, monitor and tracking of each medical claim and the identification of disconnects that bring errors to the payers attention andor identify where further education and assessments are needed to improve performance across the organization. Mc. Kesson Medical Coding and Compliance Services can help your organization more effectively manage denials, increase payment velocity and transition to value based care, all with experienced coders who exceed industry standards of excellence. Black Horses For The King Reading Level. Complete Medical Coding Services. From full outsourcing to episodic project work, our coding services address both sides of coding by identifying missed revenue opportunities as well as potential compliance risks due to inaccurate coding. All Payers Medical Necessity Software Reviews' title='All Payers Medical Necessity Software Reviews' />Certified Professional Medical Auditor CPMA medical coding auditor certification. Show your expertise with the Certified Professional Medical Auditor certification. All Positions Administrative Clerk. Essential Functions Filing in alphabetical order Attaching copies to corresponding documents. Separate, copy, fax, and mail and. Number 0244 Replaces CPB 331 Policy. Aetna considers the following products for wound care medically necessary according to the criteria indicated below. Essentials of Case Management Key Benefits Over 30 Hours of ANCC and CCMC accredited material for nurses and certified case managers Unlimited access to the course. Find and compare Medical Billing software. Free, interactive tool to quickly narrow your choices and contact multiple vendors. Integrity of the Healthcare Record Best Practices for EHR Documentation 2013 update Editors note This update replaces the 2007 practice brief Guidelines for. All Payers Medical Necessity Software Reviews' title='All Payers Medical Necessity Software Reviews' />Medical Coding Services for Any Care Setting, Any Duration We can help you improve accuracy with ongoing, periodic or one time coding assistance across all medical specialties, care settings or with hospital charge capture assessments. Clinical Documentation Assessments We can conduct periodic audits of your internal operations by department and by provider to provide a check on coding and documentation processes and performance. Physician and Back Office Staff Training and Education We can provide on site or virtual training to address coding and documentation processes deficiencies. Our clinical documentation improvement programs, physician education sessions and medical records services will help position your staff to document more effectively, code more accurately and, in turn, receive the reimbursements you are due for services rendered. ICD 1. 0 Deep Domain Expertise Our coders successfully managed the transition to the ICD 1. Healthcare Regulatory Compliance Services. Mc. Kesson Medical Coding and Compliance Services offers, in addition to coding management, an additional oversight function to your organization for providing information and guidance on applicable federal and state statutes, regulations, and other payer requirements. Some compliance services are available to healthcare organizations with their own medical billing coding teams. Healthcare Compliance Plan Assessments For organizations with their own coding teams, we can evaluate your coding and documentation compliance procedures, using federal and state requirements as our guides. The evaluation will be integral as you shift your teams focus to delivering value based care. Compliance Plan Development and Monitoring We can help your team establish best practice coding and documentation compliance standards as well as processes for auditing and confidential reporting, including enforcement, response and prevention guidelines. Specialty specific Auditing We can review and evaluate the groupsindividuals responsible for monitoring, tracking and reporting charges to identify deficiencies in code and modifier assignments as well as opportunities for improvement. Provider Education Services Mc. Kessons provider education services are designed to optimize front end and back end billing processes. These services, which are offered on an annual and ad hoc basis as necessary, include Provider documentation training. Annual CPT and ICD 1. National coverage determination and local coverage determination update for CPTICD 1. Updates on regulatory guidance affecting codingdocumentation e. Quality Payment Program, IDTF policy changes, Stark Law, etc. The Strength of Mc. Kesson Coders. Correct coding for your services requires well trained and experienced specialty specific medical coders and coding management. Mc. Kesson currently has more than 6. Specialty Coding Certification To address the nuances of specialty specific coding, Mc. Kesson developed Specialty Coding Certifications SCCs. Following intensive training, coders must pass the SCC exam and accurately code selected charts with the correct CPT, modifier and ICD 1. Certified Leadership All employees issuing coding guidance internally or externally, including coding managers, supervisors and team leads, are also nationally certified as a Certified Professional Coder CPC or CPC Hospital CPC H and work one on one with their coding staff. Superstars Mc. Kesson coders demonstrate minimum accuracy levels of 9. Historically, claims coded by us have resulted in internal audit adjustments of less than 1 due to an auditors requirements. Staying True to the Mission. Our compliance efforts are designed to establish a culture that promotes prevention, detection and resolution of conduct that conforms to federal and state law, and federal, state, and private payer healthcare program requirements, as well as Mc. Kessons own ethical and business policies. Quarterly Quality Assurance Audits All production coders undergo a quarterly coding quality assurance QA audit in their specialty specific area. Approximately 6. 5,0. QA process. Coding performance is measured based on quality of work and resolution rates. Our efforts to improve never stop. Annual External Audit To affirm that Mc. Kessons oversight and direction are objective and in agreement with industry standards, each year an external auditing firm reviews a sample of the claims that Mc. Kesson has audited. Confidential Reporting Mc. Kesson maintains an anonymous compliance hotline through an external vendor for employees to report concerns about compliance issues in a confidential manner and without fear of retribution. Issues reported via the hotline are thoroughly investigated and corrective action is taken when necessary.