Provide ongoing training and support to The Centers for Advanced Orthopaedics (CAO) physicians, non-physician providers, and professional fee billing staff, clinic staff, administrators, and other personnel on third party payer documentation and billing requirements.
Using accepted auditing and analytical techniques conduct billing/chart audits, determine the adequacy of medical records documentation.
Prepare reports for CAO leadership, Divisional Administrators, and clinical departments as to the status or results of reviews. Summary reports are presented to the Revenue Cycle Committee and CAO Board of Managers.
- Conduct independent reviews/audits on the adequacy of medical record documentation to support the associated charges.
- Analyze documentation or coding patterns by a provider, division or department that poses a compliance risk and recommends solutions to address the problem(s).
- Assist Divisions and providers in developing corrective action plans to improve documentation practices, address compliance problems, or improve professional fee billing activities.
- Conduct training sessions for providers, billing staff and others on a regularly scheduled on an ad hoc basis.
- Provide feedback to providers on the results of their medical record documentation reviews and give targeted training as needed.
- Research and answer billing and documentation questions or problems submitted by Administrators, billing staff, and others to ensure compliance with specific payer regulations and CAO policies and procedures.
- Regularly monitor potential billing problems and/or billing errors identified by divisional billing office.
- Prepare and revise, as needed, a Billing Compliance Training Manual for routine and special training programs.
- Assist in development of medical record documentation standards and requirements related to clinical and surgical services billing.
- Keep current with third party regulations with emphasis on Medicare billing, teaching physician regulations, Current Procedural Terminology, ICD-10-CM Coding, and professional fee billing.
- Perform other billing and documentation compliance related activities as necessary.
- Perform other duties as required.