Custom Data Services, Inc. – Coding

Coding is the first step in accurate claims processing. With our cost effective medical coding services you can enjoy cleaner claims, fewer denials, enhanced revenue and freedom to focus on your practice.

“Revenues improve when coding and documentation practice improve.” Our experienced staff and AAPC certified coders will process CPT and ICD9 codes based on AMA and CMS guidelines.

Custom Data Services, Inc. – Coding Audits

The process of accurate coding by physicians is extremely critical in getting paid correctly and in a timely manner. It also avoids unnecessary external audits by Medicare and other payers.

With our coding audit service we compare your coding with the actual documentation you recorded in your chart. The coding audit will reveal whether any variations from national averages is due to inappropriate or atypical coding; based on your specialty and intensity of practice.

It is impossible for a physician or physicians staff to provide a chart audit because the results will be biased or a conflict of interest. However we can provide the necessary chart review that will show the what is not well documented or seemingly understood. We will choose charts at random based on the volume of your practice, and these charts will be review by our staff who have an excellent knowledge of coding rules and a strong understanding of medical terminology.

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Custom Data Services, Inc. Client Training

The collection of accurate data is an extremely important process of the MCLC. Gathering and processing incorrect or incomplete data will result in claim denials and increased cost.

We offer training services of our proprietary software to the employees of your practice to ensure the proper use of our system and to increase the integrity of the data collected. A CDS representative will provide orientation and training to the physicians office staff at their location or at Custom Data Services.

What does the training involve?

• Standard system terminology and billing terms.
• How to enter and maintain data dictionary elements including: CPT codes and pricing, practice centers, financial/department centers, invoice types, insurance companies, referring physicians, etc.
• How to enter and maintain guarantor and patient records.
• How to enter and maintain the appointment system master schedule.
• How to create, fix, move, or cancel a patient’s appointment.
• How the appointment system integrates with the patient charge system for posting daily charges.
• How to issue paid receipts for payments taken at the time of service.
• How to post payments from daily receipts from patients and insurance companies.
• How to work patient balances or overdue insurance claims.

Who is this training for?

Our training services are generally directed toward our physician services clients that will be interacting with our software directly. We will perform training for all of the employees of your practice and are willing to add additional training as new employees are hired. In our medical management services the data collection is typically done by the hospital registrars using the software provided by the hospital and then sent to us electronically, therefore training on how to use our software is generally unnecessary.

Custom Data Services, Inc. Practice Analysis

How well is your practice running? If you are considering outsourcing your billing, or are concerned with the cost effectiveness and efficiency of your current billing solution we can provide you a complete practice analysis.

What is a practice analysis?

Practice analysis is the process of determining whether or not your billing solution, in house or outsourced, is producing at efficient and cost effective levels. We have developed a series of services and benchmarks that can identify and help resolve any inefficiencies in your current billing procedures.

Coding and Documentation Review:
We will audit your charges to your chart records to determine the accuracy and appropriateness of billing. This review will include office, surgical, and hospital procedures.

Office Work-Flow Review:
We will review your office efficiency, including interviews with front counter and billing personnel. The work-flow will be analyzed to determine how well the patient information and demographics flow from the front counter to the billing department and vice-versa.

Fee Analysis:
We will analyze your charge master based on conversion factor analysis, Medicare reimbursement and the Physicians Fee Reference. This review will provide a tool to determine if your procedures are overpriced or under priced relative to conversion factor or Medicare factoring.

Payer Contract Review:
Your insurance contracts will be reviewed to determine the appropriateness of the terms and fee schedules.

Practice Assessment:
A complete review will be provided of your practices billing, payments, and disallowance over the last two years. The review will provide a complete analysis of your payer mix, billing and payment trends, and gross and net collection analysis.

An EOB audit will analyze the magnitude and types of errors requiring corrections and re-billing; the time lags between the date of service, the date charges were posted to your system, and an analysis of the types of claim denials being received by your practice.

Your account receivables will be benchmarked to determine how long it takes for you to collect a bill, your turnover ratio, and what claims are considered overdue.

Your collection protocols will be reviewed to determine if patient balances are being billed and collected. We will also review your procedures for overdue patient balances and patients that have been sent to collection.

A physician assessment will be done which includes a review of the billing, receipts, and disallowance based on physician RVU’s. This analysis will be physician specialty specific and will determine the practice mix and the profitability of your physicians.

We understand the complete process and how each phase can affect your efficiency. Click here to find out more about our medical billing services and how we can benefit your practice.

Custom Data Services, Inc. Medical Billing Services:

On our medical management and physician services pages you will notice that the first items that we list as included services are billing services.

What are billing services?

Many organizations operate under the belief that the successful reimbursement of a medical claim is what defines a billing service, but we believe that it takes more.

The successful reimbursement of a medical claim is a part of a progression we like to call the medical billing claim life cycle. Although reimbursement is a critical process in the life cycle of a claim it is not the only critical element.

In order for your practice to gain the most from a medical billing service all stages of the claim life cycle need to be met.

What is the medical billing claim life cycle?

Data Collection -> Processing -> Adjudication -> Reimbursement

Data Collection
The first phase, and in my opinion the most critical phase, of the MCLC is data collection. Data collection is performed before, during, and after the medical service has been completed. The accuracy of the collection of patient insurance information, registration information, procedural data, and physicians orders directly corresponds with a reduction in filing errors and a reduction in accounts receivable turn around time.

Processing
The processing phase involves everything after the patient has left your office. During the processing phase we perform the data entry, apply CPT procedural codes, collect additional data that may be necessary, and submit the claim for adjudication.

Adjudication
The adjudication phase begins with the electronic submission of the medical claim to the responsible party; the primary or secondary insurance, or patient. Once the claim has been submitted it will either return a result of accepted or denied. If a claim has been accepted we will begin the reimbursement phase. If a claim has been rejected we must return to the data collection phase to correct or retrieve data that was collected inaccurately. Will will refile the claim or make an appeal on the adjudication.

Reimbursement
The reimbursement phase involves receiving and dispersing payments to the correct patient accounts, storing claim explanation of benefits, and balancing accounts receivable journals. If an account has a open balance the processing phase will began on the account to recoup the remaining debt owed to you.

Conclusion Although the result of a successful revolution in the MCLC is complete reimbursement of a medical claim, it is necessary to understand that every phase of the MCLC is as important as the phase before it. Understanding the life cycle will reduce errors, reduce cost, and increase collections.