Diagnostics and Imaging

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Acevedo Consulting appreciates that optimizing diagnostic billing requires an understanding of the regulatory requirements not only of billing, but Medicare credentialing of both physicians and staff. Capturing accurate CPT codes, modifiers, correct place of service and dates of service are critical for proper reimbursement. More than any other healthcare provider, being paid for your services is dependent on someone else: the ordering physician.

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It's clear that the Medicare program is paying more attention to signed, documented physician orders when reviewing claims for diagnostic services. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Acevedo Consulting was deeply involved with the Recovery Audit Contractor's audits during the 3-year Florida demonstration program. Allow our experience and expertise to aid you in preparing for the inevitable audit.

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Whether a mobile diagnostic company, teleradiology group, or and IDTF, we can assist you with developing and implementing a compliance program that meets your needs. Our understanding of, and particular expertise in the industry's nuances is paramount to balancing risk and practicality while optimizing revenue.

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Medical Specialties

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Our client list includes the following Medical Specialty areas:

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• Anesthesiology

• Cardiology

• Dermatology

• Endocrinology

• Family Practice

• Gastroenterology

• Hospitalists/Internists

• Interventional Pain Management

• Nephrology

• Neurology

• Oncology/Hematology

• Orthopedics

• Otolaryngology

• Psychiatry

• Physiatry 

• Pulmonology

• Rheumatology

• Urology

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While many practices have compliance programs - at least in spirit - these are now mandatory for all Medicare and Medicaid providers, regardless of specialty. Acevedo Consulting has years of experience developing and implementing compliance program tailored to physician practices, both large and small.

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It's clear that the Medicare program is paying more attention to services billed by physicians through increased use of ADRs. CMS' goal is to reduce/prevent improper payments. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Acevedo Consulting was deeply involved with the Recovery Audit Contractor's audits during the 3-year Florida demonstration program. Allow our experience and expertise to aid you in preparing for the inevitable audit.

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Provider-Based Clinics

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Acevedo Consulting understands that billing for physician services under the outpatient prospective payment system presents its own set of challenges and required knowledge of regulatory requirements specific to "provider-based" billing. Capturing correct places of service and understanding which diagnostic services can be billed by the physician and which must be billed by the hospital are critical for proper reimbursement. Incorrect place of service codes has been, and continues to be, on the OIG work plan.

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It's clear that the Medicare program is paying more attention to services billed by hospitals and hospital-based providers as CMS's goal is to reduce/prevent improper payments. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Allow our experiences and expertise to aid you in preparing for the inevitable audit.

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Our understanding of and particular expertise in the industry's nuances is paramount to balancing risk and practicality while optimizing revenue.

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Therapy Services

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Acevedo Consulting appreciates that optimizing therapy billing services requires an understanding of the regulatory requirements not only of billing, but Medicare credentialing of therapists, physicians and staff. Capturing accurate CPT codes, modifiers, correct place of service and dates of service are critical for proper reimbursement.

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Since the mid-2000s, Medicare credentialing and documentation requirements have undergone dramatic changes. And, for therapists, it has never been clearer how important it is to properly document the medical necessity for services in the initial Evaluation/Plan of Treatment as well as in the Clinician's Progress Report. Beginning in 2009, Medicare began a renewed emphasis on signed physician orders, and what constitutes a "legible signature." Therapists must have solid protocols in place to meet all documentation requirements to be able to successfully respond to a Medical Review request.

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It's clear that the Medicare program is paying more attention to signed, documented physician orders when reviewing claims for physical and occupational therapy services. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Acevedo Consulting was deeply involved with the Recovery Audit Contractor's audits during the 3-year Florida demonstration program. Allow our experience and expertise to aid you in preparing for the inevitable audit.

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Whether in private practice or providing therapy services in a physician practice, Acevedo Consulting can help ensure providers meet the Medicare definition of "Qualified Personnel" and that the documentation meets payers criteria. Our understanding of and particular expertise in the industry's nuances is paramount to balancing risk and practicality while optimizing revenue.

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