Consulting Services / Tactical Reimbursement

Coding, Compliance and Reimbursement Tools

Coding and Coverage Analysis and Planning

Understanding reimbursement coding is a full time responsibility and requires extensive experience to learn strategy techniques. Appropriate coding strategies and defining suitable codes for services and products can be difficult in today's reimbursement system. The constantly changing reimbursement and coding systems within the health care industry such as HCFA's Common Procedural Coding System (HCPCS), Current Procedural Terminology (CPT), Diagnosis Coding (ICD-9-CM), Correct Coding Initiative (CCI) edits and black box edits make it very difficult to stay current. Leave the responsibility up to the experts! Turn to The Pinnacle to suit all your needs and give you all the accurate advice you need and deserve.

The Pinnacle Health Group assists clients in developing and implementing strategies for effective and efficient reimbursement. These programs consist of:

  • Coding review
  • Policy review
  • Coverage analysis
  • Development of strategic plans for coverage
  • Application filing support for new codes

The Pinnacle Health Group provides coding support for products and services in the hospital inpatient, hospital outpatient, free standing facility, physician office, ambulatory surgery center or for home use. Since guidelines for coding and reimbursement vary based upon place of service, our experts can provide support covering each specific location.

Development of Effective Reimbursement Tools

Barriers to payment are sometimes only a lack of appropriate communication tools. In today's data access environment, reimbursement is primarily driven by historical data. When customers do not have access to appropriate coding and coverage guidelines, they don't have the correct tools to teach others and they cannot stay current, resulting in arising reimbursement issues.

The Pinnacle Health Group's reimbursement experts design, build, operate and monitor innovative strategies to improve access, quality and cost-effectiveness for any biotechnology, pharmaceutical device or drug. We eliminate reimbursement barriers and streamline strategies by offering a variety of services. Some services The Pinnacle offers include:

  • Sales aids
  • General Reimbursement guides
  • Product specific coding tools
  • Payer meetings
  • Assistance with policy development
  • Reimbursement educational programs
  • Educational seminars and symposiums

The Pinnacle Health Group's team of experts have reimbursement experience that spans the past twenty years. Whether you are seeking coding assistance, assessments or answers to any questions pertaining to an industry issue, be confident we can provide you with accurate quality solutions to solve the problem.

Educational Programs

The Pinnacle Health Group provides educational programs to help understand the issues related to correct coding and reimbursement. Educational programs are custom designed programs specific for each customer. These programs may include:

  • Basics of Medicare program
  • Introduction to ICD-9-CM coding
  • Advanced ICD-9-CM coding training
  • CPT-4 and HCPCS coding training
  • Appropriate use of modifiers
  • Introduction to Medicare Outpatient Prospective Payment System (HOPPS)
  • How to use the appeals process
  • Medical necessity and Local Medical Review Policies
  • Appropriate use of the Advanced Beneficiary Notice
  • Designing a compliance program
  • Training compliance auditors

The Pinnacle Health Group will assist your organization to pass a government or payer audit and will update your policies and procedures to assure appropriate reimbursement. This will maximize your reimbursement and limit exposure to fraud and abuse. If your coding and billing experts are not on the cutting edge of coding and billing rules and regulations, The Pinnacle Health Group's experts can assist to provide the education necessary.

HIPAA Compliance

One of the most important issues and priorities facing the healthcare industry today is healthcare privacy and security. A recent survey conducted by the Healthcare Information Management Systems Society found that over 60% of health care institutions say their top priority is upgrading security and preparing for compliance with the Health Insurance Portability and Accountability Act (HIPAA). Compliance with HIPAA and other mandated regulations, both on the Federal and state levels, requires major policy, technology, educational and operations requirements. Healthcare providers must comply with this complex mix of statutes in a very short period of time.

The Pinnacle Health Group offers a wide array of services to help healthcare providers become compliant. It's HIPAA task force team includes attorneys, technology and computer experts and healthcare industry specialists. The Pinnacle offers a wide variety of services and solutions to aid the healthcare provider, including:

  • Organizational Seminars to provide basic background to the HIPAA regulations
  • Risk Assessment and Risk Management Strategies
  • Preparation and Implementation of Compliance Plans and Policies
  • CPT-4 and HCPCS coding training
  • Data Security and Privacy Audits
  • Employee Education and Training
  • Record Keeping and Reporting Policies
  • Technology Integration into Privacy Policies and Programs
  • Business Associate/Covered Entity Contract Review
  • Budgeting for HIPAA Compliance

The Pinnacle Health Group will provide practical and proven solutions and approaches to resolving the healthcare provider's compliance issues while aiding its efficiency and quality of healthcare services.

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