Ingram & Associates

Reaching the Gold Standard for healthcare revenue model optimization, financial and coding performance

Ingram provides medical coding & compliance services, with special emphasis on one of your toughest areas of medical coding: Interventional radiology and cardiology special procedures, CVIR, typically performed in angiography rooms, cardiac catheterization labs and in the operating room to ensure appropriate reimbursement and coding compliance under APCs. Ingram provides assessment audits, coding services for both historical and on-going cases, educational programs and complete turnkey re-engineering services designed to build “best practices” capabilities within organizations coding for special procedures.

We understand that specialization with an emphasis on interventional radiology and cardiology, and our experience both as practitioners and as coders can help you achieve sustainable results. It's perhaps the most complex Medicare compliance and reimbursement area where hospitals need coding help.

ZHealth Publishing, led by Dr. David Zielske, is our business partner and is dedicated to producing professional coding reference manuals and related materials for the interventional radiology and cardiology areas.

Over the past eight years Dr. Zielske and his colleagues have worked with more than 700 hospitals to provide a range of coding & compliance services, including interventional radiology and cardiology coding compliance reviews, benchmark assessments, retrospective and prospective coding services, and educational programs dedicated to improving compliance and correcting reimbursement as a result of mandated APC's. To date, Ingram has created the largest national database on case coding experience related to interventional radiology and cardiology. Our extensive case experience allows clients to continually track national trends on interventional radiology and cardiology compliance and reimbursement results and compare their coding and reimbursement results to key national and regional benchmarks.

Recent national trends indicate a fairly even distribution among hospital providers between net under-reimbursers and net over-reimbursers. Unfortunately, one common trend among all hospitals is the signficant amount of inappropriate reimbursement tied to incorrect or improperly used codes. This results in a national average for your Medicare outpatient claims of over $625 per Interventional Radiology case and over $800 per Cardiologoy case in inappropriate reimbursement in these specialty areas alone, creating signficant overpayment liability risk.

Our Audit and Assessment Review is an informative, low cost, and rapid first step that evaluates a hospital's actual experience in interventional or cardiology case coding, measures accuracy and compliance to mandated national coding standards, and determines reimbursement impact. Ingram uses copies of actual billed claims and physicians dictated reports or other relevant medical chart information to show where your hospital stands compared to national benchmarking trends so that you can benchmark your own organization's potential compliance risk and reimbursement exposure for special procedures.

Our Prospective Coding services are geared to the hospital that chooses to outsource the coding of its complex IR or Cardiology cases on a go-forward basis. Because of the complexity of this unique coding area and the clinical knowledge required to successfully manage the coding process, your organization may choose to outsource the coding of complex IR or Cardiology cases to Ingram. Since case volume is so low (typically less than 5% of the radiology procedure volume), this is a very manageable task for insuring coding compliance and proper reimbursement.

Complex IR or Cardiology cases are forwarded daily to our team of physician coding experts to correctly code each case and return that information to you. Ingram's Prospective Coding process supplements your existing billing process to insure that these cases are correctly coded and charged on an on-going basis.

If a coding & compliance problem is found via our Coding & Compliance Review, many hospitals elect to audit and correct their outpatient cases on a retrospective basis. The benefit is two-fold:

1. Retrospective coding will correct historical problem cases and get you in coding compliance since the mandate under APCs went into effect August of 2000.

2. Ensures that appropriate and correct reimbursement, whether over-reimbursed or under-reimbursed, has been received for all past cases and your future liability under potential compliance audits will insure you aren't at significant risk.

If your hospital is interested in tackling the necessary work process changes and skillset development necessary for coding success in these areas, our Medical Coding Educational Program is geared to support your internal process improvement & educational initiatives. Because of the complexity of complex special procedure coding, Ingram's educational development programs are not geared towards one-time "seminar" sessions--as these have traditionally been ineffective in skill development in the specialty areas of interventional radiology & cardiology coding. Rather, we focus on a curriculum approach combined with monthly case reviews of all your coding to provide the basis for developing the skills and expertise in becoming coding independent and benchmarking your progress to successful completion.

The educational component begins with an intensive 2 1/2 day off-site training seminar. Our Educational Programs usually run three to six months or more and are designed to build your staff skills, maintain compliance, and provide your hospital with the tracking of coding results to ensure your success and maintain compliance during the process. Educational sessions are taught both by Board Certified professionals and our special procedures consulting staff who have a focus on the unique aspects of special procedure coding.

	Anatomy
	Terminology
	Component / CPT Coding
	Modifiers & Pass-through's
	Federal Coding Standards / SIR
	Special Procedure Coding Work Processes
	Personal Case Reviews with Physician Coders

Our most comprehensive program encompasses every aspect of the hospital process for interventional radiology or cardiology coding designed to effect maximum positive "best practices" change in the fastest possible timeframe. This complete program is provided under a single consultancy fee arrangement and incorporates all the potential problem areas into a comprehensive evaluation, documentation, recommendation and implementation strategy for your organization. This process is both fast and efficient, with the typical work process implementation being completed in just 45 days. A component of this service is our Best Practices Maintenance Support Program designed to help you stay on track after this process is complete and to help to ensure that you can successfully sustain your program improvements. This program includes several phases:

Our evaluation team spends significant time on-site to evaluate and interview the various departments involved in any aspect of the coding and billing process (from radiology, the cath lab, the operating room, medical records/HIM, IT, business Office and compliance departments) to gather key work process data that will be used in making final recommendations for change. This process includes evaluation and recommendations on a number of topics including but not limited to:

The completion of this phase concludes with complete documentation of the existing workflows and operational deficiencies and provides detailed recommendations for changes necessary to achieve a successful "best practices" environment.

A comprehensive educational process will be completed along with the implementation of all related work process recommendations to insure your organization's success. Please see the section entitled Educational Programs above for more information on the training curriculum.

During this optional phase, Ingram will perform case coding reviews of your cases on a monthly basis for those cases that you wish to send to us, both to support the transitional period from evaluation to implementation, as well as to provide the appropriate post educational feedback on your internal post-education accuracy to insure that the work processes and knowledge building steps are working successfully. Both monthly and quarterly performance benchmarks will be provided as compared to the original benchmark data generated from your original audit process when this program segment is utilized. Quarterly teleconference meetings will be available to provide "mini" educational reviews of problem cases and areas requiring additional improvement.

One of the most difficult parts of any process improvement program lies beyond the improvement phase itself. Once you have made significant progress by affecting process changes and building knowledge within your organization, how do you ensure that your organization will keep pace with the constant changes in codes, coding rules and compliances standards going forward? Staying on track after process improvement initiatives are implemented is a critical success factor in long-term improvement benefits.

Our On-going Research & Maintenance Support Program is designed for organizations that wish to have on-going support and independent validation that insures the sustainability of their process improvements. This program supports both organizations that have utilized our Best Practices Process Improvement Program or have pursued improvements from their own internal process change initiatives. There are five major components of this on-going service, including:

Research is performed on an on-going basis and provided to the facility each month to track the constant changes that occur for special procedure coding. This covers a variety of information sources and research topics that are subject to continuous change throughout the year. We provid concise written reports on a monthly basis that cover a variety of topics essential to accurate special procedure coding. This includes research on CMS information, Federal Register content, AMA rules and standards, FI-specific LMRP/LCD/NCD information, announced code changes, Physician Society updates, and other hard-to-find documentation that affect coding rules and standards.

Up to 30 Chart Reviews per quarter are provided and can be used by your organization to provide customized support in a number of ways. These reviews can be used to provide you with random sampling of coding accuracy and performance benchmarking or, if you prefer, you can use these chart reviews to help your internal team with the most complex and difficult cases they must code.

Each quarter, your team also has access to members of our physician coding team via 1-Hour educational teleconferences on topics important to your team. These sessions can be used to discuss the results of quarterly chart reviews and benchmarking data, to discuss problem-coding areas that require attention, or, you can use these sessions to address specific educational topics important to your team.

Our consulting team will also provide you with an annual inspection (1 per 12 months of service) of your CDM and will provide key recommendations on changes and/or additions important to keeping your CDM and charging process up-to-date with important change requirements.

You also have access to 1 free slot per year (1 per 12 months of service, out of pocket travel expenses are not included) in any of our offered quarterly educational seminars to be used at any time during the year for any quarterly location offered by us. This is done to provide your organization with additional training support for new employees, skill development for existing staff or as refresher courses to insure their skill level is maintained and that knowledge is kept truly up-to-date. This program provides up to 19 CEU credit hours for certain credentialing certifications as well.