Why is your medical billing department not receiving proper reimbursement for medical services?  Consider ICC as an answer        

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Call ICC Today  1 (316) 683-0170

In today's health care field, many hospitals, surgeons, doctors and  clinics believe coding is the answer for proper reimbursement. Many medical professionals believe a certified coder would benefits their practice. Yet, they are still losing revenue.  If this sounds familiar, call ICC today for more information on how we can help recover your lost revenue.  ICC provides nationwide services. Below are some factors that contribute to lost  revenue other than CPT and ICD-9 code etc...              

WHAT FACTORS DETERMINE THE NECESSITY FOR MEDICAL REVIEW  AND AUDITS

• Charges exceeding usual, reasonable and customary for the geographic area
• Multiple diagnoses with questionable causation from trauma
• Diagnostic ( DRG), ( ICD-9-CM and /or procedural( CPT) codes missing or unclear
• Unbundled charges (ie., fragmenting)
• Treatment is excessive based on diagnosis and level of service required to treat an injury or illness
• Questionable diagnostic procedures/treatment
• Charges for postoperative care
• Hospital confinement is excessive for injury or illness ( LOS Guide)
• Treatment could have been provided on an outpatient basis
• Was confinement necessary?
• Medication ( I.V.& I.M. v. Oral )?
• Was Patient ambulatory?
• Home Health Care Considered?
• Hospitalized for physical therapy?

• Admitted on Friday or Saturday for elective procedures) or treatment
• Discharged on a Monday
• Excessive diagnostic studies- repeat studies on same day
• Treatment with physical therapist and chiropractor on same day
• Ancillary charges do not appear in line with the room and board charges
• Too Low - Just for rest
• Too High- Overcharged? Excessive Lab? Excessive Diagnostic?
• Excessive medication? Duplication of diagnostics?

• Two or more surgical procedures performed during one hospitalization
• Extensive charges for blood, plasma and/ or solutions
• Setup charges on emergency room bills
• ICU care needed for minor injury or illness

Why do insurance companies and government ran hospitals consider an IME :

• The treating provider refuses or cannot provide" reasonable proof" of the necessity and reasonableness of treatment.

• The treating provider will not or cannot provide a treatment plan with prognosis
• The patient is showing no signs of improvement based on the clinical records
• The diagnosis, prognosis, treatment, plan, attending physician or medication charges change during treatment

  The schedule of treatment does not change, i.e., three times per week continues throughout the treatment.

  The medical records indicate subjective complaints only and no objective signs of injury or illness.

  These are just a few of the factors which  may cause your practice to lose revenue. If you are serious about  getting your practice under control, call 1 (316) 683-0170  today .

   

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