Reference no: EM133430702

Assignment:

Task: This Reimbursement Monitoring and Reporting (RMR) Checklist provides students with opportunities to investigate realistic claims rejection cases that are "written off" in an outpatient setting and write recommendations that provide guidance to providers, practice managers/staff, and medical billers. This activity integrates the importance of documentation, compliance, coding quality, management and leadership. The RMR Checklist consists of two parts. This counts as 10% of the course grade.

Part I: Calculation of Physician Fee Schedule of Monthly Write off and Recommendation.

There are seven "write off" scenarios in an outpatient setting "Outpatient Monthly Write off CY ___ Quarter 2016," which students will provide recommendations related to:

1. poor documentation;
2. no authorization;
3. frequency issues;
4. coordination of benefits;
5. downcoding of E/M codes;
6. unbundling of procedure codes;
7. Medicare reimbursement policy regarding assistant surgeon.

Calculate the physician's fee for every service performed per month using the www.CMS.gov site Physician Fee Schedule website. Add the total amount per month.

• For documentation issue recommendation, students will query physician and/or educate physician; design and complete the documentation requirements of Operative Report and indicate documentation needed to support procedures and diagnosis.
• For authorization and frequency issues recommendation, students will create a practice policy to implement ABN for Medicare or Waiver of Payment for other payers non-covered services.
• For E/M downcoding issue, students will complete E/M Documentation Auditor's Instruction to determine the accurate level of E/M code; if downcoding is supported.
• For unbundling issue, students will use Encoder Pro Physician Compliance Edit to show NCCI edit, apply modifier(s) to bypass edits and print the NCCI edit result
• For Medicare Modifier 80 reimbursement policy, student will create medical necessity letter of the procedure performed by the Assistant surgeon (modifier 80)

Part II: Investigate potential fraud and abuse with these rejections that are written off, and justify the application of the AHIMA Code of Ethics. Determine the importance of coding quality and accuracy through ongoing monitoring and reporting. Recommend necessary procedures/policy for monitoring and reporting, documentation compliance and compliance with insurance reimbursement policy. Describe the role of the health information professional regarding coding quality, compliance, and reporting. Describe the role of the provider regarding clinical documentation improvement.

As the Revenue Cycle Coordinator, you have been directed to create the Quarterly Write-off Report. Use the www.CMS.gov Physician Fee Schedule website to identify the physician fee. Calculate the physician fee for each CPT code with the number of cases to obtain the total amount for each CPT code. Add the Total Amount per month.