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Overview
Understanding and complying with local reimbursement policies, procedures, and interpretations of national Medicare programs is key to receiving appropriate reimbursement for services performed. Policies for reimbursement are continually being updated by the Centers for Medicare & Medicaid Services (CMS, formerly HCFA). Ultimately these national programs are interpreted, and local policies are developed and administered by Fiscal Intermediaries, and Medicare Part B Carriers.
The Local Reimbursement Consultation provides NMD customers accurate and up to date reimbursement information specific to their location. This is accomplished by interacting with and researching the correct answers from local Intermediaries and Carriers. All recommendations for reimbursement program improvements are documented. The goal of the program is to insure that our valued customers are in compliance with the local reimbursement policies and procedures affecting them, and therefore are appropriately reimbursed for services provided. The consequences for being out of compliance and perhaps incorrectly reimbursed are potentially very costly. Via a locally focused and detail oriented approach the local reimbursement consultation brings a great deal of value to our customers, and is unique in the market.
If you would like information on how NMD Healthcare may support your reimbursement program please contact us at 609-584-8470, or email at ken@nmdhealthcare.com.
The process includes a review of the following:
CHARGE MASTER
Comprehensive review to ensure correct assignment, appropriateness and compliance of the Physician's Current Procedural Terminology (CPT) Codes, The National Uniform Billing Committees (NUBC) Revenue Codes, Health Care Financing Administration Common Procedure (HCPCS) Codes, International Classification of Diseases -9- Clinical Modification (ICD-9CM) Codes and Evaluation and Management Codes.
REVIEW UB-92 CMS-1450 CLAIM FORMS
Detailed review to identify Form Locator deficiencies or reporting irregularities involving the Technical Component prior to the submission to Medicare for complete and accurate reimbursement.
CMS-1500 CLAIM FORMS
This review is similar to the UB-92 HCFA-1450 Claim Form Review with the distinction of resources devoted to analysis of the Professional Component.
CMS NATIONAL MEDICARE POLICIES
This component service reviews the pertinent policies as they apply to the specific hospital department or office practice personnel. All policies and procedures applicable to the delivery of services, claims processing instruction, billing procedures, coverage requirements and related Medicare matters are reviewed for up to date accuracy and regulatory compliance.
FISCAL INTERMEDIARY and MEDICARE CARRIER LMRP'S
This service reviews the hospital, clinic, or physician office policies with the correct accompanying "family" of codes to ensure compliance with the Local Medical Review Policy and therefore proper reimbursement for procedures performed and the pharmaceuticals and supplies used. Issues or questions which are unclear from the LMRP are researched with the FI or Carrier and documented at the time of the consult.
FEE SCHEDULES PART B
This product is available to assist providers in the development of proper charges for procedures and supplies in their specific pay locality.
MEDICAL DICTATION REPORT REVIEW
This portion of the consult involves a detailed review of the medical dictation report corresponding to submitted claims to ensure the report's terminology and conclusions are appropriate and compliant with local policy for the codes utilized.
CORRECT CODING INITIATIVE COMPLIANCE
New coding edits are released by CMS as part of the National Correct Coding Initiative on a quarterly basis. The local consult insures that your department or practice is in compliance with the CCI updates and edits affecting your specialty.
APC PROCEDURE and SUPPLY CHARGES
Research and review of appropriate Ambulatory Procedure and Supply Codes for services provided to insure appropriate and compliant reimbursement in the hospital outpatient setting. Notification and documentation of proposed HOPPS changes are provided when availiable.
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