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ACE, Inc. Services
Our goal is to assist you in taking an objective look at your coding, billing, and business practices to assure that you are legally collecting everything for anesthesia and pain management services performed.
Assessing risk and improving your organization’s processes and compliance practices is more important now than ever. With healthcare reform and corporate due diligence in the headlines stakeholders must take the responsibility seriously to ensure that they are compliance with all legal standards. That is where ACE comes in…
We understand the idiosyncrasies of anesthesia time, medical direction, ancillary services and many more hot topics in your specialty. We understand the risks that pain management physicians face in evaluation and management coding and medical necessity issues. We have the expertise to help you navigate the turbulent seas of Medicare and Medicaid regulations.
ACE Client segments include:
Anesthesia Practices
Pain Management Clinics
Ambulatory Surgery Centers
Hospitals
University Hospitals
Health Care Attorneys
Malpractice Insurance Companies
Please take a look at the services below to explore how ACE can be of service to you.
Our compliance audit process begins with good documentation. We review the anesthesia record, operation room record, and the billing information submitted to your billing agent. We then review the actual CMS 1500 to determine accuracy and appropriateness of the bill submitted.
The anesthesia record is the document that will determine the services provided when reviewed by an auditor. This record will be compared to the operating room record completed by the circulating nurse to verify procedures, times and anesthesia personnel involved during the procedure.
ACE now offers full time anesthesia coding professionals to code for groups. Whether it is an emergency situation, filling in for vacation, staffing changes or the group is in need for a full time coder, we have the resources to code for your group. We charge a flat fee per record and all coders have more than ten years experience in the field of anesthesia coding. Don’t let your cash flow suffer due to inadequate coding resources … let us help you!
In an environment where it’s so important to bill and code correctly, this gives you an opportunity to have the coverage with the skills and confidence to ensure the proper coding of the services provided.
ACE, knows that you hold essential the values for an active compliance program and understand compliance is a long-term ongoing commitment. The OIG model compliance plan indicates that to ensure a compliance program is being followed a group should conduct periodic audits.
Do you have trouble getting around to getting the monthly auditing done? Let ACE be your monthly auditing agent.
ACE can again assist your practice in remaining compliant. As you know, our staff has the expertise to assist in all phases affected by compliance guidelines.
We have put together a list of items that we believe every practice should be checking on throughout the year in order to demonstrate active compliance. In the past we have given the lists for you to do. We know how busy you are so, now we are offering to do them for you.
We propose that monthly audits are focused on specific items as follows:
January – Anesthesia time review
February – Post-operative pain, including daily management
March – Line documentation review
April – Medical direction elements review
May – Monitored Anesthesia Care, medical necessity
June – Concurrency, relief services
July – Coding; ICD-9-CM and CPT/ASA coding verification; modifiers
August – OB anesthesia
September – Reimbursement
October – Pre-operative evaluation, physical status
November – Contract verification for one insurance
December – Monitoring AR guidelines against National Benchmarks
The program would work like this. We agree on a twelve month schedule. The group will be sent an E-mail on the 20th day of the Month requesting the information. This information will be due in our office by the 5th work day of the following month. Chart reviews will be limited to 25 charts. We will perform the task, document it for your compliance plan and if findings are significant, we will have a telephone consultation with you as to the proper corrective action steps that should be taken. This will help to keep your plan active and your finger on the pulse of compliance for your practice.
The fee is $500 per month payable by the 15th of the following month. We are limiting this to ten practices so if you are interested, please call.
Outsourcing your billing function requires a special oversight responsibility from physicians. Not only do you want to be sure that they are submitting your claims correctly, it is also important to insure that you are getting paid properly for the services that you perform.
In recent reimbursement audits, we have found numerous errors resulting in physicians not being compensated correctly. These audits focus on reviewing accounts receivable reports, contracts, explanations of benefits and denials received from the claims files.
Holding billing companies accountable is an important element in your compliance activities.
Now you don’t have to send your staff across the country for the best conference on pain management and compliance training. ACE will bring their extensive knowledge to you office!
This workshop is a comprehensive combination of:
Instruction on Documentation – solid advice for the physicians for completing medical records that meet government requirements
Education – designed for physicians, CRNA’s and office staff to promote awareness of billing regulations and compliance throughout your organizations
Assessment/Evaluation – an exam is administered at the end of the course to be sure the participants understand the materials covered. You’ll uncover any weaknesses in your staff so that retraining can be addressed.
BUSINESS PLANNING & OPERATIONAL REVIEW
Sometimes an outsider can help you see the bigger picture. ACE consultants are available to visit your practice and conduct a basic assessment in all areas. We can offer beneficial feedback and suggestions for improvement.
There are times when you need someone just to step in for a while. ACE, Inc. has the knowledge and expertise to keep your practice running smoothly without missing a beat. Call to discuss the variety of options.
Initial On-Site Operations Review
Evaluate current operations, including patient flow, information flow, space and floor plan, medical record, computer system.
Establish statistics to monitor daily, weekly, monthly, quarterly, annually.
Review staff task assignments, staffing levels, job descriptions, staff training.
Assist in developing short and long-term goals. Assist in plan to reach goals.
Review marketing plan. Assist with marketing strategies.
On-Going Practice Oversight
Five hours of phone contact, additional hours available at $150.00 per hour
On-going monitoring of billing activity
Monthly phone conference
Review insurance carrier contracts.
· Monitor allowable by carrier
· Assist with contract negotiation strategies
Updates regarding CPT and ICD9 coding.
Research answers to questions
If you’re thinking about starting a new practice, ACE will walk you through the entire process, from finding the right location, making sure the floor plan is efficient down to your grand opening.
An ACE auditor will answer all your questions and meet any challenge. We cover revenue and expense projections, staffing ratio and expense, capital expenditure, business and marketing plans, finance options, insurance contracts, employee benefit options, procedure manuals, job descriptions, employee manual, OSHA, CLIA, compliance HIPAA, computer software and hardware options.
Planning, understanding, and training will allow patient care to be the most important issue for physicians and staff when the clinic opens.
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