MediRegs Coding Suite

Transcription

1 MediRegs Coding Suite Specialized health care solutions to accelerate coding compliance and ensure accurate and timely reimbursement MediRegs Coding Suite from Wolters Kluwer Law & Business is a web-based revenue cycle solution designed specifically for health care professionals who need a comprehensive, easy-to-use set of tools. Combining the ease of the MediRegs content platform and coding tools with the specialized content of the CCH Medicare & Medicaid Guide, Coding Suite features the most robust coding, reimbursement, research, and compliance web resources available. Whether you need a simple coding tool integrated with medical necessity information, support for claims processing rules and edits, a provider-specific Medicare-compliant reimbursement resource or critical audit analytical tools, there is a Coding Suite product configured to provide what you need to work efficiently. Available in three levels, Coding Suite is designed to meet the varying needs of your organization: Coder s Resource Center (CRC): Our basic solution, CRC is a perfect fit for staff members who need easy access to coding information. Coding & Revenue Resource Center (CRRC): The mid-level, CRRC goes beyond basic coding to include payment calculators, edit-checking tools and everything you need to understand the claims processing system. Audit & Revenue Resource Center (ARRC): Our advanced version, ARRC is the most sophisticated coding payment compliance audit resource available. It includes exceptional coding tools, claims calculators, robust archives, and exclusive content from CCH, AMA and AHA. By combining code search and book research in one location, Coding Suite provides you with a unique solution that is easy for your organization to use, without any specialized training, including: Code Explorer, a custom search engine designed to facilitate coding research and ensure Medicare claims compliance. With the click of a button, coding, payment, coverage and guidelines are present in one simple workflow. Our expansive research library, the MediRegs Coding Guidance Library, provides everything a coder needs to avoid the pitfalls that certain codes lead you into. The Guidance Library integrates primary source material direct from CMS to ensure compliance with: MUEs, NCCI edits, RAC issues, CERT reports, FAQs; benefit, claim processing and coverage requirements; PQRI coding and more. Electronic Codebooks that integrate coding and payment information, allow you to bookmark and are updated well ahead of the typical paper publication ship date. Automatic Updates - alerts include local coverage determinations, state Medicaid and Medicare updates and coding changes personalized for your location and preferences. Exceptional Archives - Dial back in time with historical manuals, codebooks, calculators and LCDs necessary for appeals and audit work. BASIC LEVEL Coder s Resource Center Basic level includes e-codebooks, Code search, Medical Necessity, NCCI and ICD-10 for medical office staff, scheduling & registration staff, and is an ideal solution for coding students. MID-LEVEL Coding & Revenue Resource Center Mid level features advanced code research tools, groupers and calculators for inpatient, outpatient and physician reimbursement for coding and billing specialist, insurance specialists, HIM professionals, reimbursement analysts, CDM coordinators and is also a great solution for HIM students. ADVANCED LEVEL Audit & Revenue Resource Center Advanced level includes detailed claims calculators, robust regulatory resources, archives, state Medicaid and more for audit specialists, fraud investigators, denials management, department heads.

2 The Coding Suite is available in three levels - which level is right for you? Each Resource Center is all-inclusive with no additional add-on fees. Choose the level that fits your content needs begin with the basic level or move up to the advanced level, our most comprehensive. For subscribing organizations, a blended solution is available where each staff member can subscribe to whichever Coding Suite, Compliance & Regulation Suite, Aspen Publications and CCH Medicare & Medicaid Guide resources they prefer. Coder s Resource Center (Basic) Coding & Revenue Resource Center (Mid-Level) Audit & Revenue Resource Center (Advanced) Includes Everything from Basic Level PLUS... Everything from Basic and Mid-Levels PLUS... Developed For Basic coders, medical office staff, introductory coding students, scheduling and registration staff Coding and billing specialists, certified coders, insurance specialists, HIM professionals, advanced HIM students, billing companies, reimbursement analysts Chargemaster & revenue cycle specialists; fraud and denials management staff, audit specialists, compliance analysts Coding Tools Simple Code Explorer, ICD-10 Explorer, NCCI Checking PLUS 10 electronic codebooks PLUS Advanced Code Explorer, ICD-9 & ICD-10 to MS-DRG Grouper, Code Notes, Coding Comply Downloads tool & Drug Lookup PLUS Robust Coding Archives Specialty Content WKL&B Coding Compliance Advisor and MediRegs Educational Webinars PLUS CPT Assistant CPT Changes: An Insider s Guide, ASA Crosswalk PLUS AHA Coding Clinic for HCPCS, AHA Coding Clinic for ICD State Information Customized to your Contractor: All Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) and National Coverage Information PLUS Customized to your state: Health Care Laws & Regulations, Medicaid Manuals & State Medicaid Plans Compliance Resources CMS transmittals, MLN Matters, Frequently Asked Questions & Job Aids PLUS CMS Manuals for benefit policy, claims processing & coverage; E-Book Version of Final Rules for OPPS, IPPS, Physician Fee; Specialty workspaces for Inpatient, Outpatient, Physician, Pharmacy, Laboratory & Medical Device specialists. PLUS Complete Regulatory & Compliance Solution: All CMS Manuals; Federal and state health care legislation and regulations; Specialty workspaces for Audit, PPS, MMA, Part D, HIPAA, FDA, OIG, HHS, Stark, Managed Care and more. Fees & Payment Payment status indicators and national unadjusted payment rates are integrated into the HCPCS & CPT coding resources PLUS MediRegs Quick Calculators for APC, RVU & MS-DRG PLUS Seven additional Case Calculators for OPPS, IPPS, Phy. Fee, LTCH, IRF, SNF, IPF; Fee schedule archives Powered by MediRegs Online access to content you can search and browse; customized Daily Alerts; Weekly Alerts; Stored Search Alerts and Personal Bookmark Folders Electronic Code Sets Include HCPCS, CPT, ICD-9-CM, ICD-10-CM, ICD-10-PCS, GEMs, APC, RVU, MS-DRG, NCCI, PQRI, IOCE, MCE, POA/HAC and more

3 Coder s Resource Center The basic coding solution with medical necessity, coding guidance and instant alerts Designed specifically for the non-coder professional who needs to understand code, the Coder s Resource Center (CRC) is a perfect fit for staff members who need instant access to coding information. With simple, natural-language lookup tools that include brand name and key term mapping, you ll be able to search dozens of resources simultaneously without needing to be a coding expert. Automatic web updates, e-books, search tools, and downloadable data files are included in a single cost-efficient yearly subscription. Whether you are responsible for assessing medical necessity in scheduling or registration, coding medical records, running operations in a medical office or working in the HIM department, CRC provides the real-time updates required to ensure proper code assignment up front, minimizing your claim denials and maximizing your efficiency. Coding Tool Features With simple search functionality, CRC makes it easy to search across multiple code sets by code, description or key terms. In an instant, verify coding, diagnosis/procedure codes and see what is payable and what is covered from one place. ICD-10 Explorer provides keyword search functionality for ICD-10 codes and guidelines, as well as translation of ICD-9 to ICD-10 codes using GEMs mapping scenarios. NCCI Code Pair Checking tool demystifies code bundling issues. Now includes Medicare edits! E-Code Sets and e-books allow you to search by code, description or common terms. Integrate with the explorer tool and reduce your coding orders and subscriptions. Includes complete electronic codebook content for HCPCS, CPT, APC, ICD-9-CM, ICD-10-CM, ICD-10-PCS, GEMs, Physician Fee Schedule (RVU), MS-DRG, NCCI, E&M, and Drugs (NDC) in natural language. Medical Necessity Resources Instant access to LCDs and NCDs provide effective validation of the medical necessity of ordered outpatient and physician procedures and services. Additional access to Advanced Beneficiary Notification (ABN) forms and instructions, national coverage guidance (NCD), national coverage analyses (NCA). Choose by contractor: All Medicare Administrative Contractor (MAC) LCDs and bulletins are included for specific local guidance. Coding Guidance Resources A medical dictionary, CMS glossary, MLN Matters, Job Aids, fee schedule information, acronym tool and frequently asked questions further expand the list of reference material you can access before a code is assigned. Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it. Includes Wolters Kluwer Coding Compliance Advisor Newsletter and MediRegs educational webinars. DEVELOPED FOR Basic coder Medical office staff HIM professionals Scheduling and registration staff Introductory coding students INCLUDES Simple Code Explorer, ICD-10 Explorer NCCI Code Pair Checking tool Access to 10 electronic codebooks State Information Customized to your Contractor: All Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs) and National Coverage Information Compliance resources including: -CMS Transmittals -MLN Matters -FAQs -Job Aids Wolters Kluwer Law & Business Compliance Advisor MediRegs Educational Webinars

4 Coding & Revenue Resource Center Go beyond basic coding with a mid-level research solution focused on claims processing, coding, payment and revenue The Coding & Revenue Resource Center (CRRC) goes beyond basic coding to include payment calculators, edit-checking tools and everything you need to understand the claims processing system. With additional guidance on claims processing, this level is the ideal solution for expert coders, revenue cycle, reimbursement & HIM/CDM professionals who need coding, revenue and payment tools and key regulatory content relevant to coding. CRRC will provide you with real-time updates that you need to ensure proper code assignment up front, minimizing your claim denials and increasing your bottom line. Coding Tool Features Advanced Code Explorer allows users to search across multiple code sets by code, description or key terms for instant coding instruction (Code Notes), outpatient and physician payment rates and coding guidance including local coverage determinations and critical coding guidance in one location. CCH Coding Comply database offers complete code lists and descriptions, with archives and a simple way to custom export codes from our database. ICD-10 Explorer provides keyword search functionality for ICD-10 codes and guidelines, as well as translation of ICD-9 to ICD-10 codes using GEMs mapping scenarios. NCCI Code Pair Checking tool demystifies code bundling issues. Now includes Medicare edits! MS-DRG Grouper makes classifying inpatient claims easy, with either ICD-9 or ICD-10 codes. E-Code Sets and e-books allow you to search by code, description or common terms. Integrate with the explorer tool and reduce your coding orders and subscriptions. Includes complete electronic codebook content for HCPCS, CPT, APC, ICD-9- CM, ICD-10-CM, ICD-10-PCS, GEMs, Physician Fee Schedule (RVU), MS-DRG, NCCI, E&M, and Drugs (NDC) in natural language. Coding Guidance Resources Includes a comprehensive Coding Guidance Library with more than three dozen coding supplements, including CPT Assistant, CPT Changes - An Insider Guide archives and ASA Crosswalk. A medical dictionary, select CMS Manuals, and Medicare coding and billing guides further expand the list of reference material you can access before a code is assigned. Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it. DEVELOPED FOR Coding and Billing Specialists Insurance Specialists Reimbursement Analysts CDM Coordinators Certified Coders Billing Companies Advanced HIM students INCLUDES TOOLS FROM CODER S RESOURCE CENTER PLUS: Advanced Code Explorer ICD-9 & ICD-10 to MS-DRG Grouper Code Notes Coding Comply Downloads tool Drug Lookup Coding Guidance Library, including: -CPT Assistant -CPT Changes - An Insider Guide archives -ASA Crosswalk Key CMS Manuals used by coders: -CMS Claims Processing Manual -Benefit Policy Manual -National Coverage Manual Payment system final e-books: -Inpatient PPS -Outpatient PPS -Physician Fee Schedule and Ambulatory Surgical Centers MediRegs Quick Calculators for APC, RVU & MS-DRG

5 Compliance Resources Access the key CMS manuals used by coders, including full versions of the CMS Claims Processing Manual (Pub ), Benefit Policy Manual (Pub ) and National Coverage Manual (Pub ) provide you with detailed instructions to comply with Medicare. Learn Medicare s stance on these codes, along with the common pitfalls behind them. Payment system final rule e-books including: inpatient PPS, outpatient PPS, physician fee schedule and ambulatory surgical centers make understanding changes simple. WK Week In Review Newsletter keeps you abreast of regulatory, legislative and enforcement activities across Medicare. CMS Transmittals, MLN Matters, Job Aids and CMS Frequently Asked Questions are updated daily to keep you apprised of real-time coding changes and discussions as they are released in one easily accessible place. RAC Tracking tool helps you stay abreast of codes being investigated by government investigators. A medical dictionary, CMS glossary, MLN Matters, Job Aids, fee schedule information, acronym tool and frequently asked questions further expand the list of reference material you can access before a code is assigned. Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it. Includes Wolters Kluwer Coding Compliance Advisor Newsletter and MediRegs educational webinars. Medical Necessity Resources Instant access to LCDs and NCDs provide effective validation of the medical necessity of ordered outpatient and physician procedures and services. Additional access to Advanced Beneficiary Notification (ABN) forms and instructions, national coverage guidance (NCD), national coverage analyses (NCA). Choose by contractor: All Medicare Administrative Contractor (MAC) LCDs and bulletins are included for specific local guidance. Fee and Payment Tools Easily reference the adjusted Medicare reimbursement rate for your region via the MediRegs quick calculators for APC, RVU and MS-DRG. Demystify bundled codes with the NCCI Code Pair checking tool, which is integrated automatically into the APC & RVU calculators.

6 Audit & Revenue Resource Center Advanced, Robust Tools for Audit & Denial Management Research, Complex Coding Issues and Payment Analysis for Multiple Reimbursement Methodologies Created for high-level health care professionals, Audit & Revenue Resource Center (ARRC) is the most comprehensive coding, payment and compliance audit resource available. Leveraging content and tools from Coder s Resource Center (CRC) and Coding & Revenue Resource Center (CRRC) as a foundation, ARRC provides the advanced primary source content and tools you need to ensure program and revenue integrity and proper audit trail documentation. Coding Tool Features Robust archives for coding, payment, local coverage determinations, CMS manuals and federal regulations. Advanced Code Explorer allows users to search across multiple code sets by code, description or key terms for instant coding instruction (Code Notes), outpatient and physician payment rates and coding guidance including local coverage determinations and critical coding guidance in one location. CCH Coding Comply offers complete code lists and descriptions, with archives and a simple way to custom export codes from our database. ICD-10 Explorer provides keyword search functionality for ICD-10 codes and guidelines, as well as translation of ICD-9 to ICD-10 codes using GEMs mapping scenarios. NCCI Code Pair Checking tool demystifies code bundling issues. Now includes Medicaid edits! MS-DRG Grouper makes classifying inpatient claims easy, with either ICD-9 or ICD-10 codes. E-Code Sets and e-books allow you to search by code, description or common terms. Integrate with the explorer tool and reduce your coding orders and subscriptions. Includes complete electronic codebook content for HCPCS, CPT, APC, ICD-9- CM, ICD-10-CM, ICD-10-PCS, GEMs, Physician Fee Schedule (RVU), MS-DRG, NCCI, E&M, and Drugs (NDC) in natural language. Coding Guidance Resources Includes a complete Coding Guidance Library with more than three dozen coding supplements, including AHA Coding Clinic for ICD & HCPCS,CPT Assistant, CPT Changes - An Insider Guide archives and ASA Crosswalk. A medical dictionary, select CMS Manuals, and Medicare coding and billing guides further expand the list of reference material you can access before a code is assigned. Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it. DEVELOPED FOR Chargemaster and Revenue Cycle Specialists Denials Management and Audit Specialists Fraud Specialists and Denials Management Staff Reimbursement and Compliance Analysts INCLUDES TOOLS FROM CODING REVENUE & RESOURCE CENTER, PLUS: Robust coding archives Complete Coding Guidance Library, including: -AHA Coding Clinic for ICD & HCPCS -CPT Assistant -CPT Changes - An Insider Guide archives -ASA Crosswalk Full versions of CMS Manuals: -CMS Claims Processing Manual -Benefit Policy Manual -Natural Coverage Manual State health care regulations, legislation and Medicaid manuals for all states. Real-time adjusted Medicare case calculators

7 Compliance Resources Includes full versions of CMS Manuals. CMS Claims Processing Manual (Pub ), Benefit Policy Manual (Pub ) and National Coverage Manual (Pub ) provide you with detailed instructions to comply with Medicare, and outstanding archives for audit and appeal work. WK Week In Review Newsletter keeps you abreast of regulatory, legislative and enforcement activities across Medicare. CMS Transmittals, MLN Matters, Job Aids and CMS Frequently Asked Questions are updated daily to keep you apprised of real-time coding changes and discussions as they are released in one easily accessible place. RAC Tracking tool helps you stay abreast of codes being investigated by government investigators. A medical dictionary, CMS glossary, MLN Matters, Job Aids, fee schedule information, acronym tool and frequently asked questions further expand the list of reference material you can access before a code is assigned. Customizable daily and weekly alerts, stored search alerts and personal bookmark folders provide you with the information you need, when you need it. Includes Wolters Kluwer Coding Compliance Advisor Newsletter and MediRegs educational webinars. Medical Necessity Resources State health care regulations, legislation and Medicaid manuals for all states. Instant access to LCDs and NCDs provide effective validation of the medical necessity of ordered outpatient and physician procedures and services. Additional access to Advanced Beneficiary Notification (ABN) forms and instructions, national coverage guidance (NCD), national coverage analyses (NCA). Choose by contractor: All Medicare Administrative Contractor (MAC) LCDs and bulletins are included for specific local guidance. Fee and Payment Tools Understand the complexity of Medicare claims payment with real-time adjusted Medicare case calculators: the CCH Reimbursement Toolkit calculators for OPPS, IPPS, SNF, LTCH, IPF, IRF and Physician Fee Schedule. Easily reference the adjusted Medicare reimbursement rate for your region via the MediRegs quick calculators for APC, RVU and MS-DRG. Demystify bundled codes with the NCCI Code Pair checking tool, which is integrated automatically into the APC & RVU calculators.