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APC Performance Review Plan |
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Since the introduction of the APC system for Medicare outpatient procedures, confusion and underpayments have been the rule rather than the exception. CMS estimates that if all hospitals had correctly implemented the APC system, payments from CMS would increase by 50%. Many facilities are leaving dollars on the table by not correctly implementing a proper charge capture and coding system to gain appropriate APC reimbursement. re|solution has developed a comprehensive program to recapture dollars lost to improper outpatient Medicare billing. The program starts with an analysis of outpatient billings for a quarterly or yearly period. The analysis then provides a roadmap for review of the medical records to determine accurate coding. Once the review is done, re|solution analysts perform the rebilling of affected claims. Training of charge entry and coding personnel is also included to prevent the errors from recurring.
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