Strafford Consulting Provided Services

At Strafford Consulting we provide a host of services based on experience and knowledge of the hospital industry.  With over thirty years spent helping hospitals we know what it takes to make your hospital run more effeciently.  Offered services Scribe/Coding Services , Coding Services , Emergency Department Facility Leveling Review , Infusion/Injection/Hydration Documentation/Coding Review , Emergency Department Revenue Cycle Review , Offshore Implementation, Management and Reporting Consulting Services  can show you in easy steps what you need to do effectively.

Consulting Services SCS will continue to offer the same effective services that we have offered to physician practices, billing services and hospitals for over twenty years. These include: Documentation/Coding Reviews A valid sampling of Ed charts will be reviewed for documentation completeness and accuracy. The charts willl be recoded by our coder/auditor personnel. A report will be prepared comparing our findings with client coding. Specific feedback will be provided on documentation/coding deficiencies. Inservicesz on documentation/coding will be provided for key personnel.

Billing Operations Integrity and Performance Audit A valid sampling of source documents will be tracked in spread sheet format through the entire billing/collection process. The following will be tracked and measured:   TAT from DOS to Billing TAT from billing to payment Unpaid claims measured Follow up processes System Integrity. Accountability for all services rendered Review of Billing/Collection and A/R Ageing Reports Identification of process weaknesses

Emergency Department Facility Leveling Review In 2010 CMS provided 11 Guidelines for determining Emergency Department Levels of Service. See Addendum 1. But none of these guidelines provide a methodology for determination a given Level of Service. The result has been a hodgepodge of ED leveling approaches from the ACEP approach to point systems, to hybrids of matrixes and point systems. In reviewing thousands of ED charts as well as Medicare Data, We have identified wide variances in ED Leveling not accounted for by practice differences among the EDs. Many hospital Ed Levels are well below national standards with the bell curve peaking at 99282. This indicates that that many services that could be coded at 99283 at 140.18 per service are being coded as 99282 at 87.85 per service with a loss of 52.33 per service. We have also seen many EDs well below the national average for 99284. Under coding 99284 as 3 represents a loss of 82.99 per service. Extrapolating these losses over a 50,000 annual visit ED can represent significant revenue losses.

If this is potentially the situation with your ED Leveling, Strafford Consulting will provide the following: As a starting point Strafford Consulting will review your ED Leveling Tool for completeness and accuracy. Necessary revisions and additions will be made. A sampling of ED charts will be reviewed and relevelled by our certified clinician coders A spreadsheet will be prepared itemizing our finings compared to hospital leveling. Reasons for differences will be documented Feedback will also be provided on quality and completeness of ED chart documentation. AAn education session will be scheduled with your coding staff. focusing on specific Ed Leveling issues On going review and follow up will be provided. For more information Strafford Consulting Services can help you with your Emergency Department Facility Leveling Review contact us.

Infusion/Injection/Hydration Documentation/Coding Review In reviewing thousands of Emergency Department Charts, Strafford Consulting has identified major issues with documentation of infusions/hydrations and injections provided in the Emergency Department.

Not documenting Hydration Start/Stop times eliminates coding and billing of Hydration (96360-61) This represents a loss of 75.69 for each hydration. Not documenting Infusion Start/Stop times results in down coding to IV Push The result is a loss of 89.44 each time an infusion (96365) must be down coded to an IV Push (96374) Poor documentation can also be a compliance issue since CMS is focusing on Infusion/Injection/Hydration Coded but not properly documented. Documentation of physician order, route of administration, and dosage of medication are often not complete and legible.

Strafford Consulting, Inc. will provide the following: A sampling review of ED Charts with Infusion/Injection/Hydration Services Sampling will be coded based on documentation. SCS coding will be compared to hospital coding Narrative explanation of disagreements will be documented. Report will be providing detailing documentation issues with plan for improvement. An Infusion/Injection/Hydration Documentation Template will be provided. For more information on how Strafford Consulting Services can help you with your Infusion/Injection/Hydration Documentation/Coding Review contact us.

Emergency Department Revenue Cycle Review The Emergency Department more then ever is a critical gateway to the hospital system. The “front end” of much of the revenue generated by the hospital originates in the Emergency Department. Despite this, there is often a lack of focus on the Emergency Department Revenue Cycle. Certainly the fact that the ED generates much less revenue than the hospital can be a factor in where hospitals place priorities. Also the ED revenue cycle is unique and doesn’t fit well in into Hospital Revenue Cycle modeling. But a poorly functioning ED revenue cycle effects not only ED, but all Hospital “down stream” revenue. Strafford Consulting Services will review each process that affects the ED Revenue Cycle.

ED Chart Documentation. Complete documentation is a necessity for both ED physician and facility revenue generation. Is there a pre-billing documentation completion process. Is there ongoing feedback and education on chart documentation. Is the documentation process helping or hindering the revenue cycle. Is an EMR in place? Have Scribes been considered? Demographic/Insurance Information Capture. Complete and accurate patient information are critical to controlling ED accounts receivable. As Health reform is phased in, complete information capture will becomevene more essential Insurance Verification. It is not enough to simply register insurance. Are systems in place to verify insurance coverage. Charge Capture Integrity. 3-5% of ED services are simply lost charges. What systems are in place to to assure that all billable services are identified and billed. Cash Collections. Is there an effective point of service collection process? Is there a process that allows for real time coding so that real collections can be implemented at POS. Financial Reporting IS there complete and accurate financial reporting for the ED? Strafford Consulting will review and analyze ED performance reporting.

Strafford Consulting will review and document all processes that impact the ED Revenue Cycle. Detailed recommendation that will impact revenue generation will be provided.

Offshore Implementation, Management and Reporting Consulting Services The BPO space in healthcare has exploded in the last decade. Many of the major billing companies and large Emergency Department Management Companies are off shoring many or most of their revenue cycle processes. Coding, Data Entry, Cash Posting and A/R Follow Up and Denials management are often processed 12.000 miles or more from your practice or hospital. One BPO also codes 10% of ED services coded in the states. But for many reasons including controversy about off-shoring there is very little over site and analysis of this process. In fact statistics on the volumes of healthcare transaction processed overseas simply aren’t available. A billing company, medical practice or hospital that is considering off shoring needs over site and management to prevent potential disaster. Understanding SLAs and TATs and what they mean to your practice is critical. For these reasons SCS is offering the following:

BPO selection and contract negotiation Implementation oversight from planning through “go live” Development of meaningful off shore tracking reports On going management of the off shore relationship Meeting Management Cross cultural communications assistance.

We also offer our services to practices who outsource to domestic billing services who either are being off shored or are concerned that they have not been informed of an off shore relationship by their billing or coding vendor.

Coding Services

SCS has provided coding services to multiple specialties for over twenty years. SCS has provided Emergency Department Physician Coding to billing services, ED practices and ED practice management Firms in 18 states. Our coders are certified clinicians with an average of 15 years experience. Because of our low cost structure SCS is able to keep prices very reasonable. SCS is also providing coding to Pathology, Hospitalist, surgery and Cardiology practices. SCS now provides ED Facility Levels coding with the same experience and expertise.