All Coders—US Citizens working on U.S. Soil Important for HIPAA and ComplianceImportant for HIPAA and Compliance Dual certified within first year Including RCCIncluding RCC 3 or more years of radiology coding experience Coder samples reviewed quarterly Benchmark: 95% or higher accuracyBenchmark: 95% or higher accuracy Most coders are also interventional or diagnostic coding specialistsMost coders are also interventional or diagnostic coding specialists Custom coder access Client coding profile Radiology Services Coding

PBN processes 1 million radiology CPT’s per year PBN’s radiology clients represent over $35 million in annual revenue Longevity: 1 radiology client with PBN since radiology client with PBN since additional radiology clients with PBN for 10+ years4 additional radiology clients with PBN for 10+ years Radiology Coding Experience

Transcript to CoderyteTranscript to Coderyte PBN CPC, RCC reviewPBN CPC, RCC review Radiologist Specialist Coders Missing documentation to client weeklyMissing documentation to client weekly Physician specific educationPhysician specific education Never Downcode Correct claims checked against: CCI, Duplicate, and payor-specific editsCorrect claims checked against: CCI, Duplicate, and payor-specific edits Corrections made prior to initial filingCorrections made prior to initial filing Claim Filing Pre-Edits Radiology Coding Lifecycle

Radiology Coding Best Practices Optimized Billings Reports that could achieve a higher level of service (or additional billable codes) with appropriate documentation are returned to the client each week for additional documentation (pre-billing).Reports that could achieve a higher level of service (or additional billable codes) with appropriate documentation are returned to the client each week for additional documentation (pre-billing). Physician Education Regular documentation education with physicians in order to capture all services being provided. Common deficiencies include E&M billing, conscious sedation, PQRI.Regular documentation education with physicians in order to capture all services being provided. Common deficiencies include E&M billing, conscious sedation, PQRI.Auditing Internal auditing of each coder annuallyInternal auditing of each coder annually External auditing of each coder annuallyExternal auditing of each coder annually – Audit scope and frequency based on regulatory changes, practice changes, coder experience, previous audit results. – Results provided to client All billing staff audited annually at a minimumAll billing staff audited annually at a minimum

Customizable Solutions — Payors Standard A/R work flow A/R queues worked aggressively based on Average Days to Pay (No more than 45 days):A/R queues worked aggressively based on Average Days to Pay (No more than 45 days): No response triggers follow upNo response triggers follow up – Online status check – Phone call Denied claims:Denied claims: – Appeal / resolve within 30 days of receipt of denial Focus on future denial preventionFocus on future denial prevention Over 120 day A/R below 20% from DOS (PBN Radiology at 18.63%)Over 120 day A/R below 20% from DOS (PBN Radiology at 18.63%) Example custom solutions All claims called on after 30 daysAll claims called on after 30 days Medicaid / Medicare eligibility checks in the first 30 daysMedicaid / Medicare eligibility checks in the first 30 days Special invoicing solutions for charges billed to outside parties (i.e. hospitals)Special invoicing solutions for charges billed to outside parties (i.e. hospitals) Custom queue designsCustom queue designs Pre-appointment insurance verificationPre-appointment insurance verification Pre-appointment deductible / coinsurance verificationPre-appointment deductible / coinsurance verification

Customizable Solutions — Patients PBN standard process At adjudication to patient responsibility:At adjudication to patient responsibility: – Day 1 – statement 1 – Day 28 – statement 2 (pre-collection letter) – If no response: – Review for Medicaid / Medicare eligibility / other account problems – Call patient as needed – Turn over to collections 24 hour online patient customer service and payment portal.24 hour online patient customer service and payment portal. Dedicated customer service department for all incoming callsDedicated customer service department for all incoming calls Example custom processes Auto dialer calls:Auto dialer calls: – After 1st statement – Pre-collection Live calls 30 days after first statementLive calls 30 days after first statement Second statement at 35 daysSecond statement at 35 days Pre-collection live calls based on dollar amount (over $500 gets 2 calls, over $100 gets 1 call)Pre-collection live calls based on dollar amount (over $500 gets 2 calls, over $100 gets 1 call) Customized pre-collection letterCustomized pre-collection letter

Follow-up Methods: PBN standard process Client / specialty focusedClient / specialty focused Radiology denial resolution expertiseRadiology denial resolution expertise Extensive use of internet for verification of eligibility, claim status and appeals around time)Extensive use of internet for verification of eligibility, claim status and appeals around time) Calling: Often the easiest way to resolve a claimCalling: Often the easiest way to resolve a claim Coder review of all coding related denialsCoder review of all coding related denials Electronic error capture from the 4010 acceptance file.Electronic error capture from the 4010 acceptance file. HE 4010 ACCEPTANCE FILE. Payor relationship management Regular meetings with major payors to discuss ongoing problemsRegular meetings with major payors to discuss ongoing problems Project submission for bulk appeals caused by payorsProject submission for bulk appeals caused by payors Ongoing attendance at payor sponsored seminarsOngoing attendance at payor sponsored seminars Proven success permanently resolving denial problemsProven success permanently resolving denial problems

Denial Prevention and Resolution Preventing denials = more money, faster Denial trend analysisDenial trend analysis Monthly detailed review of systemic denialsMonthly detailed review of systemic denials Denial root cause analysisDenial root cause analysis Meetings with PBN liaison, IT and A/R staff to determine potential solutions for preventing recurrence of specific denial issues.Meetings with PBN liaison, IT and A/R staff to determine potential solutions for preventing recurrence of specific denial issues. Liaison follow up with client / hospital staff / facility staff as needed.Liaison follow up with client / hospital staff / facility staff as needed. Follow-up Methods:

Examples S UCCESSFULLY P REVENTED R ADIOLOGY D ENIALS Pre-claim filing medical record review for medical necessity for Medicare / Medicaid Pre-claim filing medical record review for medical necessity for Medicare / Medicaid PBN built “LCD” lists for Medicaid and other known payor specific policies. PBN built “LCD” lists for Medicaid and other known payor specific policies. Assisting hospitals with building “drop down” ordering indications lists Assisting hospitals with building “drop down” ordering indications lists System changes to capture hospice indicators and automatically add the appropriate modifier. System changes to capture hospice indicators and automatically add the appropriate modifier. PECOS – identifying referring physicians that are not enrolled in PECOS and working with them and hospital medical office staff to expedite enrollment. PECOS – identifying referring physicians that are not enrolled in PECOS and working with them and hospital medical office staff to expedite enrollment. Denial Prevention and Resolution Preventing denials = more money, faster Denial trend analysisDenial trend analysis Monthly detailed review of systemic denialsMonthly detailed review of systemic denials Denial root cause analysisDenial root cause analysis Meetings with PBN liaison, IT and A/R staff to determine potential solutions for preventing recurrence of specific denial issues.Meetings with PBN liaison, IT and A/R staff to determine potential solutions for preventing recurrence of specific denial issues. Liaison follow up with client / hospital staff / facility staff as needed.Liaison follow up with client / hospital staff / facility staff as needed.