|
No matter what the challenge, we always strive to provide a
complete solution that exceeds expectations. And when the "whole" is
greater than the sum of its parts, we’re particularly gratified. Here are
some examples:
MEDICAL DEVICE REIMBURSEMENT
CHARTING A PATH TO EARLY SUCCESS
SITUATION
A small medical device start-up, whose fortunes rested on a single product in
clinical trials, sought to define its most promising reimbursement strategy as
it prepared for launch.
Similar technology was already being sold in the U.S. by a large medical device
manufacturer. This gave us a basis for comparing and contrasting potential options.
HOW WE HELPED
Our consultants performed an in-depth environmental analysis to uncover coding,
coverage and payment issues associated with the competitor’s product and
comparable technologies.
FINDINGS
Research revealed coding controversies surrounding the competitive offering. These
snags led multiple payers to refuse coverage. Moreover, the competitor was denied
approval of a new CPT code to remedy coding concerns.
IMPACT
Our analysis paved the way to a more effective reimbursement strategy, enabling
our client to avoid the same errors that hindered its primary competitor. Furthermore,
this freed the single-product company to reallocate resources, so it could focus
on repositioning its market entry and coding application.
back to top
MAXIMIZING PAYMENT FOR HEALTHCARE SERVICES
REIMBURSEMENT 101
SITUATION
Administrators for the cardiology department of a large academic medical center
were alarmed at the rate at which Medicare and private insurers were denying payment
for services. Unsure about how to remedy this problem, they asked us for advice.
HOW WE HELPED
Our team conducted a comprehensive assessment of their coding and billing documentation
and procedures to identify probable root causes. This included a detailed analysis
of the department’s entire chargemaster.
FINDINGS
As we systematically reviewed the department’s policies, procedures and paper
trail, we uncovered numerous opportunities to strengthen the correlation between
its various diagnostic procedures and the CPT and ICD-9 codes selected to represent
those tests. We even discovered a missing CPT code that should’ve been included
on its chargemaster. Ultimately, we standardized the department’s documentation,
and taught the staff methods to improve coding and billing accuracy.
IMPACT
With a better infrastructure in place, and heightened staff understanding of reimbursement
fundamentals, the department has significantly improved its ability to secure
payment for services. In fact, by adding the missing CPT code to its chargemaster,
the department estimates that its net payments increased by $1.5 million in the
first year.
back to top
FAST-FORWARD TO ACCREDITATION
A WINNING APPROACH
SITUATION
In 1999, a physician called us, urgently seeking assistance when his ob-gyn practice
was denied accreditation by the American Institute of Ultrasound in Medicine (AIUM).
Because he specializes in high-risk pregnancies, the doctor relies heavily on
ultrasound services – and he wants patients and other professionals to be
assured he adheres to the highest standards of care.
HOW WE HELPED
Time was of the essence, and the physician is located outside of California. So,
rather than conducting our customary on-site investigation and accreditation preparation
programs, we worked "from a distance" to uncover and resolve all outstanding
issues.
FINDINGS
Relying on our knowledge of ob-gyn and organizational protocols, we quickly pinpointed
the underlying causes of denial, and provided clear, specific remedies to every
obstacle. As a result, the practice quickly reapplied and was accredited.
IMPACT
Our knowledge of best practices and our flexible approach made it possible to
respond rapidly, without the need for costly and time-consuming travel. So, it’s
no surprise that the physician is relying on us for another round of successful
guidance, as he prepares to renew his accreditation.
back to top
|
