PROVIDER SOLUTIONS

Value Care Documentation Services Vs Volume Care Payments: Medicare and payer payments to providers are driven by the value providers add to the delivered care to patients and not by the volume of patients they encounter.

Clinical Documentation Improvement (CDI) Services: Clinical notes/charts made by providers drive the medical coding process. Our highly trained staff review the documentation to substantiate the medical necessity for procedures to seek legitimate payment. This review enhances reimbursement from the payers as well as avoids recoupments, penalties, and sanctions by Recovery Audit Contractor (RAC)/ Zone Program Integrity Contractor (ZPIC).

We supply the following services to help providers remain compliant: Star ratings and quality data submission mandates such as: Physician Quality Reporting System (PQRS), Meaningful use (MU) - Electronic Health Records (EHR) Stage-II, Value Based Modifier, and Medicare Access and CHIP Reauthorization Act (MACRA) - Merit-Based Incentive Payment System (MIPS). These offerings are the new mantras for providers to remain compliant in the industry. We help providers navigate these crucial areas to assure compliance and timely payment.

End-To-End Revenue Cycle Management Services: For traditional providers and hospitals we manage medical billing, coding, accounts receivable follow-up, and prepayment/post-payment audit compliance. Augustus HCS’ services ranges from demographic entry (CMS-1500/UB-04), charge capture, Electronic Clearing Service (ECS), Explanation Of Benefits (EOB) posting, accounts receivable follow-up and compliance assistance.

Medical Billing Services Accounts Receivable Follow Up Speciality Medical Coding Clinical Documentation Hospital Billing

We provide End-To-End Revenue Cycle Management (RCM) Services to help providers focus at their clinical domains. Our services are offered as consolidated package or could be availed on a-la-carte basis:-

  • Eligibility Verification
  • Claim-Generation: - Demographic Entry and Charge Capture (CMS-1500/UB-04 Forms)
  • Medical Coding-ICD-10-CM/PCS, CPT-4, CDT-5 and HCPCS-II. Charge/Demographic Entry
  • Claim Submission
  • Payment Posting and Electronic Remittance Handling
  • Denial Analysis & Insurance Follow-up
  • Compliance
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We operate dedicated Accounts Receivable (AR) Follow-up call center facility. Experienced call center executives specifically trained in US healthcare system manage AR follow-up through AVR/IVR systems as well as direct tele-conversations with Claim Processing Executives in Payer’s offices. Our AR-Follow-up services focus at following objectives: -

  • Reduce the average AR days to less than 45 days
  • Reduce the AR over 90 days to less than 10% of the total AR
  • Increase the collection from the current level to a higher level
  • Keeping claims error-free
  • Improve collections while accelerating cash flow
  • Reduce your administrative costs
  • Achieve efficiencies not attainable by billing process operated in-house
  • Expert revenue cycle specialists

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  • Home Health and Hospice Care Coding:- Home Health Prospective Payment System (HH-PPS) drives the revenue for home-health agencies (HHA). Our certified and highly experienced Home Health and Outcome and Assessment Information Set (OASIS) coding specialists help HHAs to comply with following challenges:-
    • OASIS-C-1 and upcoming OASIS-C-2 congruency and proving the Medical Necessity of therapy and skilled nursing services.
    • Star Rating and Quality Assessments Only (QAO) Compliance through judicious use of PBQM/ Outcome-Based Quality Improvement (OBQI).
    • Easy walk during Recovery Audit Contractor (RAC)/ Zone Program Integrity Contractor (ZPIC) audits by minimizing the risk of receiving Additional Document Request ADRs.
  • Interventional Radiology Coding : Our expert and experienced coders process the IVR charts for assigning the codes while analyzing the complexities of clinical anatomy of cardio-vascular circulation including the aspects of patho-physiology such as :
    • Families/Orders of the vessels accessed and access points
    • Locations of the Catheters/Stents negotiated
    • Other interventions

    All our IVR coders are Life Science Graduates Certified with credential- Certified Interventional Radiology Cardiovascular Coder (CIRCC) (AAPC) to make your task an easy equation.

  • Inpatient Procedure Coding with ICD-10-PCS : Coding with ICD-10-PCS is the job of specialist coders who are capable of understanding the surgical anatomy and following aspects
    • Basis of surgical procedures such as Medical System, Root Operation, Approach, Qualifier and device(s) used.

    All our ICD-10-PCS coders are AHIMA/AAPC certified in ICD-10 systems and help the surgeons to make appropriate Surgical notes to get best ICD-10-PCS codes to best describe the actual procedure(s) performed for optimum reimbursement.

Medical documentation has become really the challenge post implementation of Affordable Care Act than ever before in the past

Proving the medical necessity of the services as well as ruling out the liability towards medical negligence are the challenges before the providers for making smarter clinical documentation

Utilization Reviews conducted in the light of Accountable Care Organizations (ACO) trifecta (Cost/Quality/Patient Satisfaction) whether or not a provider is ACO is the big challenge for the provider’s community. We make it easy through the onsite and offsite training/consultation and support services for all types of providers. Some of the significant verticals in the area of prudent clinical documentation are mentioned below :

  • Prepayment and Post payment audits revolve around inappropriate usage of modifiers 25, 59 and 91. New modalities appended to modifier 59 (XE/XS/XP/XU) add up to the challenges of clinical documentation the providers should made.
  • These modifiers are on the lens of Office of Inspector General (OIG) Program to ensure providers just don’t try to get escape from National Correct Coding Initiative (NCCI) edits by using inappropriate modifiers.
  • Evaluation and management E/M coding and EM levels determination is made easy with the help of expert and certified Clinical Documentation Improvement (CDI) specialists on our board.

Augustus HCS performs hospital billing under UB-04 (DRGs) as well as hospital outpatient billing under Outpatient Prospective Payment System (OPPS) based on Ambulatory Payment Classifications (APC).

We have well trained, certified and experienced coders who are ICD-10 certified and well versed with Inpatient Prospective Payment System (IPPS) as well as OPPS.

Our services help hospitals trim Discharged Not Final Billed (DNFB) as we help hospitals create prudent clinical documentation, which is completed concurrently, while patient is undergoing acute care treatment.

We ensure compliant clinical documentation in terms of Complication or Comorbidity (CC)/ Major Complication or Comorbidity (MCC) and Present on Admission (POA) criteria as well as work closely with inpatient clinical providers to avoid hospital readmissions under Improving Medicare Post-Acute Care Transformation (IMPACT)-Act-2015.