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J. A. Holloway &
Associates provides a wide range of consulting and technical
services to health care organizations. We specialize in projects
involving coding, reimbursement, and documentation of health
services and therefore offer the following services:
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- Compliance Programs &
Strategies
- Coding & Reimbursement Validation
Studies
- Coding & Documentation Improvement
Reviews
- Charge Master Reviews
- Preparation for Conversion to New Coding
& Reimbursement Systems
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Compliance Programs
& Strategies
We
provide healthcare organizations with information and expertise to
develop, implement, and maintain a Compliance Program for Coding,
Billing, and Clinical Documentation. As part of this service, we
perform the following: |
- Evaluate organizational compliance in areas
of coding, billing, and medical record
documentation
- Identify high-volume and high-risk
areas
- Provide a methodology for developing,
implementing, and maintaining a realistic and meaningful
compliance program
- Assist in developing policies and
procedures, audits and monitors, and mechanisms for
identifying potential compliance issues on an ongoing
basis
- Benchmark the facility’s patient encounter
data with other external entities (e.g., HCFA, OSHPD, etc.)
in order to identify potential compliance problems
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Coding &
Reimbursement Validation Studies
We provide hospitals, ambulatory surgery centers,
physician offices, and home health agencies with an external review
of the quality of diagnostic and procedural codes submitted for
reimbursement and compliance with regulatory requirements. As part
of this process, we perform the following activities:
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- Select a random or focused sample of
medical records to review
- Assess the accuracy of the ICD-9-CM codes,
the HCPCS/CPT codes including E&Ms and the
appropriateness of the DRG, APCs, DCG or HCC
assignment
- Provide a written report that summarizes
our findings on the types of errors, the projected impact on
reimbursement, and recommendations for improving the
documentation, coding and reimbursement
- Provide in-service educational programs for
coders, billers, and physicians
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Coding &
Documentation Improvement Reviews
J. A. Holloway & Associates assists hospitals in
evaluating their manual and automated systems to ensure that they
effectively support accurate and timely documentation, coding, and
DRG assignment. As part of this process, we perform the following
activities: |
- Develop recommendations that address the
organization, systems and procedures, workflow, and staffing
of the documentation and coding processes
- Work with case managers, health information
management professionals, and the Medical Staff to develop
and implement improved mechanisms for collecting information
critical to patient care, coding, reimbursement, and
compliance
- Provide and help implement diagnosis and
DRG-specific documentation improvement tools
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Charge Master
Reviews
We assist in
the review, validation and updating of Charge Masters to ensure
accurate coding and reimbursement. Our reviews include:
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- Validation and correction of CPT/HCPCS
Codes, Code Descriptions, and Revenue Codes
- Identification and correction of
inappropriately bundled and unbundled services
- Analysis of infrequently used services in
order to identify charge master problems
- Interviews with ancillary department
personnel to clarify and further specify services
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Preparation for
Conversion to New Coding & Reimbursement
Systems
We prepare
healthcare organizations for transition and conversion to new coding
and reimbursement systems. This includes preparation for:
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- APCs, HCFA's upcoming Outpatient
Prospective Payment System for hospital outpatients
- ICD-10 for diagnoses and ICD-10-PCS for
procedures
- New standardized data sets to comply with
HCFA’s Health Insurance Portability and Accountability Act
(HIPAA)
- HCFA’s documentation guidelines for E&M
codes
- Transitioning the coding function to the
electronic medical record
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