Our on-site compliance review is a comprehesive audit that begins with provider documentation and ends with account activity and collection notes. This review is structured to:

• Fulfill annual compliance audits as a part of an internal compliance program.
• Assess code assignment accuracy and compliance for services through a review a documentation and coding.
• Review reimbursement for accuracy and comparison to MGMA and ASA benchmark data.
• Fulfill requirements for annual education.

The results of an on-site compliance review will include but is not limited to the assessment of the following:

• Pre-evaluation and plan documentation

• Medical direction or supervision documentation

• Relief services documentation

• Concurrent case review

• Time analysis, which includes monitoring and rounding analysis

• Ancillary services documentation

• Evaluation and management services documentation

• Post-operative rounding documentation

• ICD-9-CM and CPT-4 coding review

• Base unit discrepancies

• Modifier designation

• Medical necessity for MAC

• Assessment of PQRS measures

• Compliance with Correct Coding Initiative (CCI) bundling edits

• Verification of appropriate completion of records to comply with carrier billing requirements

• Reimbursement Analysis

In today’s environment, every dollar counts. Every practice needs a watchdog that ensures managed care contracts are followed, co-pays are collected, and collection activity is done in a timely, effective manner. Many hospital agreements require an outside look at collections when stipends are involved. ACE provides an objective opinion and accountability through our process.

Our reimbursement review incorporates education and training for your entire staff. ACE works independently to ensure the billing company or your staff is doing everything legally possible to effectively collect money owed.

Outsourcing billing requires special physician oversight and responsibility. Not only must you ensure claims are submitted correctly, but the practice is getting paid properly for what is performed. In recent reimbursement audits, we have found numerous errors of incorrect physician compensation. These audits focus on accounts receivable reports, contracts, explanations of benefits and denials received from claims files to streamline your bottom line.

Our Coding Division consists of certified, highly experienced staff in the specialty of anesthesia and pain management. ACE Coders are utilized as an extension of many practices and billing companies’ coding departments for both long and short term projects. Our coders are production-based, priced by the record.

A coding engagement begins with a planning call to discuss your group’s specific needs such as volume, frequency, turn-around time, and workflow. We have a great deal of experience with remote coding workflow and are equipped with tools to ensure an efficient and productive coding process. As with all our services, ACE will tailor the process to best suit your business.