Preparing for the RACs

• Identify Risk Areas
• Implement DRG audits
• Assign a nurse auditor to review medical necessity & high-risk areas
• Billing Compliance
• Pharmacy/Ancillary Charges in Chargemaster

Healthcare Services
Our Healthcare experts specialize in strategic planning, organizational development, physician compliance programs, HIPAA updates, facilities management, auditing services, and tax services.

We are committed to helping our hospital, ambulatory surgery center and physician clients meet the challenges of today's healthcare environment:

• Decrease cash collections
• Reimbursement reduction
• Code and documentation updates
• Federal and state regulations
• Litigation issues

 Healthcare Articles

Healthcare Regulatory 2009 Update

Coding and Documentation 2009 Update
    2009 Diagnosis Code Changes
    2009 CPT Code Changes
    2009 HAC & POA Indicator Reporting
    Preparing for the RACs
    Top 10 RAC/OIG Targets
    OIG Work Plan

Employee Benefit Plan Alert: Fiduciaries must focus on Plan Fees

The Potential Liability of Self-Funded Health Insurance Plans

Physician Services


 HealthLine Newsletter Articles

Healthcare Litigation

Health Claims Authorization, Processing and Payment Act

Healthcare Organizations Start to Adopt Sarbanes-Oxley Regulations

The OIG Stresses the Importance of Internal Controls for Hospitals to Reduce Risk

View all HealthLine Issues

 Archives - Healthcare Articles

Healthcare Regulatory 2008 Update

Coding and Documentation 2008 Update
    2008 Diagnosis Code Changes
    2008 CPT Code Changes
    2008 Modifier Changes
    Consultations
    MS-DRG and Present on Admission
    OIG Work Plan
    Increasing Revenue In Your Practice

2007 Medicare Update

2006 Medicare Update

2006 Medicare Bulletin: Nine-day hold on all Medicare payments

2005 Healthcare Update

2005 New Jersey Healthcare Bulletin

2005 Healthcare Events Update

Medicare and Medicaid (CMS) Alert

2005 Medicare Update ACAP Convention
Healthcare Coding and Documentation 2009 Update

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Presented by
Amper’s Healthcare Services Group

Preparing for the RACs
  • Identify Risk Areas
    • Inpatient
      • Surgical Procedures in Wrong Setting
      • Excisional Debridement
      • IRF Services Following Joint Replacement Surgery
      • Cardiac Defibrillator Implant in Wrong Setting
      • Treatment for Heart Failure & Shock in Wrong Setting
      • Respiratory System Diagnoses with Ventilator Support
      • Extensive OR Procedures Unrelated to Principal Dx
      • DRG Changes Due to Wrong Dx Code or Principal Assignment
      • DRG Changes Due to Wrong Procedure Code(s)
    • Outpatient
      • Speech-Language Pathology Services
      • Infusion Services
      • Colonoscopies
    • Physician
      • Pharmaceutical Injectables
      • Vestibular Function Testing
      • Duplicate Claims
  • Implement DRG audits
    • Monitor upcoding/downcoding
  • Assign a nurse auditor to review medical necessity & other identified high-risk areas
  • Billing Compliance
    • Review bill error/correction reports
    • Review incorrect units billed
  • Pharmacy/Ancillary Charges in Chargemaster
    • Verify units of service
    • Verify correct dosages
   

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