Billing Claim Reviews

Our services in billing and claims management and analysis extend throughout the complete claims process. We focus on coding practices—past, current planning for future changes. The skills we teach your staff will allow them to stay up-to-date in even the busiest setting.

Set-up and/or Review of Charge Description Masters (CDM)

Lack of periodic maintenance of the charge description master can not only leave dollars on the table for practices but may also expose your site to liability. Merlino Healthcare Consulting will provide the most up-to-date code and payment information as we identify the procedures performed at your facility and review your CDM for the proper elements. Our review includes:

• Current Procedural Terminology (CPT®) codes and modifiers
• Healthcare Common Procedure Code System (HCPCS) codes
• Hospital Revenue Codes
• All code descriptions and units
• Correct Coding Initiatives (CCI) edits
• Medicare Physician Fee Schedules (PFS) and/or Medicare Ambulatory Payment Classification (APC) System Rates
• Review of Facility Charges
• Report, Claim and Payment Review

Select a representative sample of your UB-92 (1450) and 1500 claim forms, and send us the final reports and the remittance form from the payer for an analysis (we also provide report- and claim-only review). All materials are kept confidential and returned or destroyed at the end of the review. We will research the Medicare national and local medical review policies (LMRP), payment rates and CMS frequently-asked-questions, as well as the AMA CPT® assistant clarifications. Our review includes:International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM)

• Current Procedural Terminology (CPT®) codes and modifiers
• Healthcare Common Procedure Code System (HCPCS) codes
• Hospital Revenue Codes
• All code descriptions and units
• Correct Coding Initiatives (CCI) edits
• Medicare Physician Fee Schedules (PFS) and/or Medicare Ambulatory Payment Classification (APC) System Rates
• Review of Facility Charges

We will complete a summary report/bill audit form with an analysis of our findings. Merlino Healthcare Consulting provides post-review education, such as coder training or physician documentation, to all facility staff requested.

Payer Advocacy

Merlino Healthcare Consulting can assist you with all aspects of your local and national payer issues. We will facilitate written and verbal communications with payers; facilitate meetings and prepare participants for discussions and negotiations; and provide economic and clinical documentation and assistance to resolve unsubstantiated claims delays or denials.

Merlino Healthcare Consulting investigates and reviews current Local Medical Review Policies (LMRP) and national coverage policies that affect your practice. We will help you stay up-to-date and enhance your practice relationships with payers, as well as obtain the resources and documentation you need.

Billing Practice Management Evaluation, Planning and Benchmarking

Merlino Healthcare Consulting reviews billing practice management tracking and reporting and will plan and implement improvements. We identify important billing requirements and documentation, and offer a billing planning timeline for ensuring and maintaining compliance.

If you wonder how your facility compares to similar practices, we will help you to find comparative data and implement simple methods for on-going tracking.

Do You Want to Know More?

If you are interested in finding out more about our services, contact us at Merlino Healthcare Consulting Corp. and we will provide you with a personalized quote for our services.