Federal Billing, Coding and Compliance Services
Compliance Plans with Billing Policies & Procedures
We have implemented over 100 provider compliance plans, which include state specific rules regarding billing policies and procedures for Medicare, Medicaid, and BCBS.
We also review existing compliance plans to see if they really are “effective” which is the threshold used by the government. Typically, we find that a compliance plan is “canned” and not tailored to the group, has not identified the risks of the group, and has not implemented a set of policies and procedures as required.
Fees: Compliance Plan with Policies & Procedures - First Discipline (e.g. Anesthesia) - $1,500. Each additional discipline $1,000 (e.g., chronic pain).
Periodic audits are required for an effective compliance plan, in order to ascertains the risk areas in a practice, including coding, billing, documentation, Stark, professional courtesy, etc. Since we are attorneys, our audits are done under the umbrella of the attorney-client privilege to the extent allowed by law. These audits are performed by our certified professional coders and include an Executive Summary, a database of each code audited, showing our comments, sorted by provider.
Our methodology is to request a list of the codes used most often, which we combine with the codes we know to be target areas, and from that, we determine the list of codes we want to audit.
The OIG recommends an audit of at least 5 claims per provider per year. The minimum number of claims audited in a single audit is 50.
Fees: $35 per claim
Phase I is the Coding Audit, in which our certified coders determine whether you billed the correct codes. In many audits we find that codes are routinely omitted either due to lack of knowledge, provider error, or data entry omissions.
Phase II is the EOB Analysis, i.e., auditing your billed claims and allowed charges against your remittance advices. This includes reviewing the managed care contracts for the proper allowable by contract; and reviewing statutory fee schedules for government payers. The allowables are then incorporated into an Excel spreadsheet to be compared to the actual EOB remittance advices from Medicare and third party payers.
Phase III consists of our deliverables to you. Our findings are reported in an executive summary analyzing each pattern issue, each overpayment and each underpayment. Additionally, each claim is broken down into approximately 25 “fields” of information so you can dissect every relevant piece of information about each claim.
Since many payers do not pay according to the terms of their contracts, either by accident, incompetence, or by intent, this audit is designed is to reveal whether the payer’s Allowed Amount, Allowed Unit Rate, Paid Amount, and claims processing delays are in accordance with applicable regulations and contract terms.
Fees: $60 per claim
V&A provides on-site PowerPoint inservices to physicians, either through their own practices or through hospitals who sponsor the inservice. These educational programs each last about 90 minutes, including Q&A.
Fees: $2,500/day + reasonable travel expenses
Vaughn & Associates LLC