Coding Review Reimbursement/Regulatory Assistance & Appeal Service

A comprehensive review of a practice’s coding patterns and documentation provided by a trusted source such as the Society for Vascular Ultrasound (SVU) is invaluable. The recent expansion of the Recovery Audit Contractor (RAC) audit process from Medicare to Medicaid and the provisions of the Affordable Care Act to increase screening of Medicare and Medicaid providers increases the likelihood of government scrutiny. Obtaining an internal evaluation of your coding and billing practices from SVU experts provides an opportunity to receive a preview of issues on which government auditors may focus.

Scope of Services



Because of the disparate needs of various SVU practices, our service provides flexibility in the extent of offered coding review services. We offer different levels of service at different prices depending on clients’ needs. Each engagement is customized for each Coding Review Services (CRS) client. Once you, the client, agrees on the scope of the project, each party will sign an engagement agreement and a Health Insurance Portability and Accountability Act (HIPAA) Business Associate agreement to allow access to private health information as necessary. The following levels of service are offered.

Level I — Risk review based on data analysis



This minimum service level includes a review of selected practice final reports and billing data. Analysis includes comparison of final reports and submitted claims for assessment of the accuracy of procedure coding as well as documentation of medical necessity. Identification of areas we deem to represent above average risk would be included in a brief written report. The estimated time required to complete this review from date of receipt of the required data would be two business weeks.

Level II — Risk review and documentation review



This service level would include all the steps listed above for Level I with the exceptions that the cases will be randomly selected to achieve the desired statistical significance and coding recommendations will be blinded to submitted claims. The final reports will be reviewed and recommended codes provided. These results will then be compared to the codes billed by the provider. A written report followed by a conference call with all stakeholders to discuss the results is then provided. The estimated time required to complete this review from date of receipt of the required data would be 30 business days. This involves a two-step process for data retrieval. The data is received and the review is completed in two business weeks as specified for Level I. At the conclusion of the data review, a list of pertinent operational and/or procedural notes would be issued to the practice. The remaining 20 business days begins when the documentation requested from the practice is received and accepted as complete by CRS. These staggered deadlines would be clearly spelled out in the proposal letter.

Level III — Comprehensive coding review service



This service level would include all the steps listed above for Levels I and II. In addition, an on-site meeting would be provided with only CRS travel expenses as an added charge to the practice. The on-site meeting would include a coding educational session for selected staff members of the practice. In addition, during the on-site visit, the review team would conduct a review of processes and inspect documentation with associated review of clinical data and pertinent Physician Quality Reporting System (PQRS), along with a brief review and commentary on the practice’s operations in connection with HIPAA Privacy and Security requirements.

Prices for each level are set by the number of providers included in the review. For further information and to request a proposal for services, please email practicesupport@svunet.org.

Additional Services

Individual Final Report

($50)
Allow our experts to review a final report and provide proper codes to use to receive the appropriate reimbursement. Call us to discuss your needs at 301-459-7550, ext.106.

Appeal Service

Many claims today are not accepted on the first request for payment. When submitting an appeal, additional documentation such as copies of notes, discharge summaries and authorizations are required. This can be time consuming and possibly run the risk of not acquiring the right information to receive full payment and maximizing practice revenue. Our consultants will help you organize appeals, figure out what information is really needed and enhance communications to maximize the results.


Contact us by:


Phone: 301-459-7550, ext 106
Email: fwest@svunet.org