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From DRGs to CPTs, the healthcare industry continues to rely on coding
and other reimbursement methodologies for crucial data gathering,
payment and compliance. At Sinaiko, we understand the practice -
and business - of medicine can be paralyzed without complete
and up - to - date coding and reimbursement system knowledge
and accuracy.
As such, we provide coding and reimbursement analytical
services to a wide range of healthcare clients on a
stand-alone basis or in conjunction with other revenue
cycle, compliance or strategic projects. In addition
to the expertise of nationally-recognized Certified
Professional Coders, Registered Health Information Technicians,
Certified Coding Specialists, and licensed Professional
Medical Coding Curriculum instructors, Sinaiko offers
turnkey coding services through The
Coding Source, LLC, an
affiliate company founded in 2002.
Clients ranging from medical groups and hospitals to
payors, investors and attorneys also rely on Sinaiko
to analyze payments based on the appropriate codes and
payment schedules, and prepare them for updates to Medicare,
Medicaid, workers' compensation and other third party
payment systems. Like all of our consultants, Sinaiko's
reimbursement specialists have frontline experience
in-and understand the real life application of-the
recommendations they provide our clients. Many also
have experience in the broader context of revenue cycle
or compliance operations. |
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Sinaiko's Coding & Reimbursement Services: |
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Coding & Professional Fee Assistance
Projects ranging from providing training for in-house
coding teams to auditing internal compliance programs,
corporate integrity agreements, litigation support
and due diligence matters.
Coding - Facility Assistance
Projects include documentation review and code capture
to ensure facilities providing inpatient and outpatient
hospital services to ambulatory surgery centers, independent
diagnostic testing facilities, long-term acute care
and inpatient rehabilitation facilities are documenting
and coding at optimum levels for appropriate reimbursement
and compliance. Sinaiko also provides facilities with
auditing for internal compliance programs, corporate
integrity agreements, litigation support and due diligence
matters.
MS - DRG Documentation Improvement Programs
Since the inception of MS-DRGs in October 2007, Sinaiko
has provided a proprietary documentation improvement
program and tools, including a 7-step plan for optimizing
reimbursement opportunities under Medicare's Inpatient
Prospective Payment System by appropriately capturing
severity levels for each Medicare inpatient admission.
The program includes auditing, assessment, training
and implementation that involves provider participation
and focuses on identifying documentation and coding
improvement needs based on specific clinical indicators
for various types of admissions. Such services can also
include complete clinical documentation improvement
programs, where appropriate.
Clinical Laboratory Assistance
Projects include assessment and auditing for hospital, referral and
specialty labs, including review and reconciliation of tests ordered
and payments received utilizing relevant clinical laboratory state and
federal regulations.
Home Health and Durable Medical Equipment Suppliers
In response to increased government scrutiny of home health and DME
services, Sinaiko provides compliance assessment and auditing services
designed to identify potential risk areas and implement compliance
improvement programs. Projects often include close collaboration with
client legal counsel.
For more information about Sinaiko's Reimbursement Services,
please contact Jeff Sinaiko at jeff.sinaiko@sinaiko.com. |
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Following an update of California's workers' compensation
payment system in 2004, an investor group retained
Sinaiko to estimate the potential impact the changes,
which were based on a Medicare payment system model
for outpatient services, would have on ambulatory surgery
centers (ASCs). |
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OCTOBER 2001
APCs: Where Are We Now?
By Sue Mote and Emma Wollschlager
Cardiovascular Disease Management |
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