Billing/Reimbursement Program Audit

Wound Center & Hyperbaric Billing/Reimbursement Program Audit Opportunities

Among other things, National Baromedical Services is a leading claims management and reimbursement authority, with 35 years of medical billing experience. Medicare Administrative Contractors (MACs) routinely contact NBS for guidance as they update Local Coverage Determinations or seek expert opinion during claims decision-making. Several MACs have engaged us to provide webinar-based and onsite training sessions for medical and claims audit personnel.

All major commercial purchases of health care likewise recognize NBS as an authoritative resource. We have provided similar training on behalf of Anthem, BCBS, Aetna, Humana and United Healthcare, and guided updating of respective Medical Policy Bulletins

Our knowledge and expertise is available to your hospital.

Upon engagement, we undertake a detailed assessment of the full scope of revenue cycle integrity. It begins by examining processes used to select facility charges for patient visit services, charge entry, and reconciliation of these daily charges. We perform this same level of assessment on professional charges if providers are hospital employees.

In addition to determining how services are being charged, the department Charge Master is reviewed to ensure that current CPT codes are being utilized and appropriate revenue codes and units of service have been established in accordance with authoritative guidelines.

Any claim denials or Additional Documentation Requests (ADRs) are reviewed to determine if problematic patterns are contributing to these events. We assess the current process for handling them and their resulting effectiveness, to determine if opportunities for improvement exist.

We review a sample of patient record documentation against the correlating UB04 claim data and remittance advice notices. This allows us to determine if coding and billing compliance and conventions are being followed and if the documentation in the medical record is supported by claims submitted to the payor.

Upon completion of our audit, client facilities can be confident that they are capturing all entitled revenue; that any areas of non-compliance with coding conventions and billing guidelines have been identified, and a plan has been presented to move forward in a fully compliant manner.