Services

                      Charge Master review

PCS can assist in the review, validation, and updating of the encounter forms(s) to ensure accurate coding and reimbursement. Our reviews include the following:

ØValidation and correction of ICD-9 and CPT/HCPS
            Level II code descriptions
ØIdentification and correction of inappropriately bundled
           and unbundled services
ØAnalysis of infrequently used services in order to
            identify charge master problems.

                                Coding Support

Onsite, offsite, or remote coding services provided by certified professional coders, in accordance with OIG and Medicare regulations.

Short- or long-term, staffing reinforcement with highly qualified coders for vacations, leaves of absences, backlog clean-up, and other staff shortage situations

                    Denial Investigation/Recovery

Based on EOB/EOMB review, all errors require an appeal to have the claim reconsidered and paid by the insurance companies once they have been denied or down-coded. Many EOB denial messages can be misleading, and most insurance companies have time limits on appeal filings. There are also some physician CPT codes that are automatically denied first time without support documentation. Claims that are not submitted properly negatively affect income and can increase liability of fraud and abuse.

                   EOB/EOMB reviews

For each claim filed, private and Medicare insurance companies issue a statement, Explanation of Benefits (EOB), listing the amount charged by the physician/provider, the amount approved by the insurance company and the amount paid by the insurance company. PCS reviews the EOB/EOMB to ensure that each claim is processed correctly and contains no errors that can cost the patient or the physician.

                                   Newsletter

Bi-monthly newsletter, which provides updates on coding and reimbursement issues.