Outpatient Review Services

Other Outpatient Audits

  • Emergency Department
  • Drug Administration Coding and Billing
  • Interventional Radiology & Cardiac Cath
  • Outpatient Surgery & Pain Management
  • Outpatient Rehab (PT-OT-ST)
  • Ancillary Services (Radiology, Laboratory, Respiratory, etc.)
  • Radiation Oncology
  • Chemotherapy Oncology Department
  • Ambulatory Surgery Centers

Outpatient Department Audits for OPPS & CAH

Outpatient Reimbursement Reviews help hospitals achieve accurate payments, improve cash flow, prevent denials and delayed payments.  ACS is committed to the facilitation of accurate outpatient coding, billing and documentation improvement for compliance with CMS regulations. ACS provides these reviews for OPPS and Critical Access Hospitals.

  • Achieving optimal reimbursement through complete documentation and accurate application of ICD-9-CM, CPT, and HCPCS Level II codes
  • Educating the medical staff and hospital staff regarding documentation to support medical necessity of services ordered and performed.
  • Updating and maintaining hospital charge master
  • Outpatient Prospective Payment System Education and Training
  • CAH Cost Payment System review along with Education for CAH staff
  • Revenue Cycle Denial Management for the OPPS and CAH

Outpatient Compliance Review

ACS consultation for Outpatient Compliance Review is designed to assess all aspects of outpatient coding, billing and documentation in all outpatient department areas. This is a complex review of selected outpatient accounts, outpatient claim rejections and corresponding billing forms such as the UB-04, Itemized Statement and Electronic Payment Remittance Advice Summary. These documents present the total picture of an episode of care, beginning from the point of order and continuing through billing and reimbursement.   Extensive education is provided to the department heads and other staff members associated with the coding, billing, documentation and charge process for outpatient services.  A final exit conference is also provided to leadership to review the findings and make recommendations for improvement.