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Compliance
Tab
Once the software has analyzed
the CDM file for coding and billing issues, and all such issues have been
addressed, the software then analyzes each line charge for potential risk
issues.
If the software identifies
a CPT®/HCPCS code or "word" within the narrative description
of a Service Charge that may trigger a potential compliance or risk issue,
the charge is placed under the Compliance tab for further review.
Entries under this tab
may contain:
- An unlisted CPT®/HCPCS
Code
- Codes with known compliance
issues such as multi-channel lab tests
- Codes that are currently
under intensified review by the FI's.
- Services that are currently
under close scrutiny by the OIG
- Non-covered services
or Non-reportable services that are kicked out by the OCE
- Common narrative that
act as flags for auditors such as "portable", "routine",
"gloves"
- Services that require
specific documentation standards for coverage
Over-billing for services,
unbundling of service charges, screening and/or routine or preventive
care are all considered compliance issues and should be noted before a
charge can be accepted as a valid charge.
Viewing
Compliance issue details
You can view more details
about the flagged compliance issue by clicking on the Compliance Issues
tab in the Active Info
window. This tab shows a brief summary of each compliance issue associated
with the current charge, along with links to associated regulations on
the Internet.
Sorting charge items by compliance issue
You can sort all the
items on the Compliance tab by compliance issue. This is useful as it
lets you easily select and deal with several related charge items at once.
To do so, click the Sort
link on the Compliance Issues tab on the Active Info window. The application
sorts the charge items on the Compliance tab so that items with the same
compliance issue are grouped together. Alternate groups are differentiated
using bands of color. The number of unique issues are displayed next to
the sort link.
To attach compliance issues
as a memo
Before sending a charge
from the Compliance tab to the Valid Tab, you should record details of
the possible compliance issue identified by attaching a Memo
as follows:
- Select the relevant charge
item(s).
- In the Active Info window,
click on the Paste To Memo 'link. Doing so will copy the compliance text into the memo window.
You can now edit or add to the pasted text before accepting the memo entry
by selecting OK.
After pasting the compliance
information into the memo window, you can modify, deactivate or include
the charge item as appropriate. Craneware recommends that you consult
a trained professional before including
or modifying entries
under the Compliance Tab.
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