AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF

67 Pages·2013·4.35 MB·English

by  Terri Mendez

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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Sue Vicchrilli, COT, OCS, is an
employee of AAO/AAOE and as such
has no financial interest or
relationship to disclose.
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Sue Vicchrilli, COT, OCS
  Academy Coding Executive
•  Email: [email protected]
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Stop self-imposed revenue cuts from
incorrect coding and poor audit
outcomes.
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Is your documentation and claim
submission your friend or foe?
  When documentation and coding
errors occur, they negatively impact
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the medical record and the practice
financial bottom line.
AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  While the physician is ultimately
responsible, correct documentation,
claim submission and claim
processing does require competent
knowledge of everyone on the
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ophthalmic team.
AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Take corrective action now.
  Awareness of resources to help.
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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Medicare             Medicare  
Part  B
Advantage  Plans
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Commercial   Medicaid
Plans
AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Mislinking diagnosis codes to CPT codes
•  #1 Reason for Recovery Audit Contractor
Audit (RAC)
•  Linking dry macular    00

degeneration
diagnosis to intravitreal injections
•  RAC can requests records for past 3 year
•  Local MAC should have denied original
payment of claims
AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES
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  Lesson learned:
•  Internal quality controls
◦  Additional training for staff
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AMERICAN ACADEMY OF OPHTHALMOLOGY AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES