Webinar Title: Conducting Cardiovascular Interventional Radiology Audits

Webinar Level: Advanced

Webinar Overview - General

The core message for this Webinar could be “Principles of conducting an Audit”. The error rates approach 60%.

Questions to think about:

• What is a vessel? You must define it.
• What is the Per Study Concept?
• Potential disconnects?

In recent years, there have been new advancements in the technology and equipment that has moved more procedures from the OR to the Interventional Radiology (IR) setting. Treatment for some of the most common and debilitating conditions are now performed using imaging guidance. As is almost always the case, many of the new procedures reach clinical practice well ahead of the new reimbursement codes needed for reimbursement.

Learning Objectives Include:

• To review and explain proper coding and billing for cardiac catheterizations, vascular catheterizations, and electrophysiological studies.
• To discuss the auditing process and the common issues that should be addressed.
• To appreciate the overall coding and billing flow for CVIR services.
• To understand the ChargeMaster and the charge capture interface for CVIR coding and billing.
• To review current problem areas for CVIR coding, billing and reimbursement.
• To discuss the need to develop coding, billing and ChargeMaster policies and procedures.
• To review current challenges with DRGs and APCs.

The following are only a few of the topics to be discussed:

I. Overview of Cardiovascular Coding, Billing, Reimbursement and Compliance
   a. Component Coding Approach
   b. Diagnostic/Therapeutic Coronary Catheterization Coding
   c. Diagnostic/Therapeutic Vascular Catheterization Coding
   d. Electrophysiological Studies
   e. APC and DRG Payment Structuring
II. CVIR Auditing Process
   a. Claims Review Process
   b. Selection of Cases
   c. Documentation Review
   d. Reimbursement Review
III. Chargemaster/Billing Considerations
   a. Chargemaster Design
   b. Charge Capture Interface
   c. Use of Modifiers
   d. Policies and Procedures
IV. Coding/Billing Considerations
   a. Coding Flow
   b. Coding Competencies
   c. Process Auditing
V. Compliance Considerations
   a. Correct Claim Generation
   b. Hospital to Physician Claim Comparisons
   c. Proper Pricing of Devices and Expensive Supply Items

Prerequisites for Participating: General knowledge of hospital services for the cardiovascular area. Knowledge of the auditing processes and techniques is needed. Some knowledge of the ChargeMaster and associated coding and billing is useful.

Suggested Attendees: Coding Personnel, Billing and Claims Transaction Personnel, Catheterization Laboratory Personnel, Vascular Laboratory Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, Physicians and Other Interested Personnel

Attendance Certificate: Upon attending this course you will receive a 2 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.