A. In business since 1986, MMR has emerged as a respected authority in the areas of ED coding, billing and reimbursement. The following strengths distinguish our organization as a service provider:

Reputation: MMR is helmed by founder and president emeritus, Caral Edelberg, CPC, CCS-P, CHC, a nationally recognized and widely respected authority in the field of emergency medicine reimbursement. As a direct result of her dedication and involvement, our organization has become the standard by which other companies are measured, emerging as an industry leader in this specialty.

Specialization: MMR was one of the first national consulting firms to focus exclusively on coding and reimbursement for the field of emergency medicine. As a result, our clients enjoy the fruits of our unrivaled expertise, best practices approach and rare industry insight into the critical issues affecting ED practices today.

Experience: MMR boasts over 20 years of experience in the field of emergency medicine billing, coding and reimbursement. Our world-class executive team includes seasoned ED administrators, ED nurses, certified coders, educators and physician group practice managers, each of whom bring invaluable knowledge and rare insight to our client services.

Values: At MMR, we’ve made it our business to protect your business. Our rigorous internal processes-including a premier compliance program, ongoing training for our staff and routine auditing of our work—ensure that we’re always doing right by our clients, and we stand behind our work 110%.

Outsourced Coding Services

Q. What do MMR's professional and/or facility coding services include?

A. MMR provides cost-efficient, outsourced coding solutions to both emergency physician groups and hospitals that employ emergency physicians. Our coding services are backed by over two decades of experience and a first-class team of highly trained professionals. Services include:

• Assignment of E/M Level, CPT, HCPCS and ICD-9 codes and modifiers for all services provided by nursing staff, emergency physicians and physician consultants for each patient treated in your Emergency Department or Urgent Care Center
• 48-72 hour turnaround time on coding
• E/M Level criteria for facility "APCs"
• Chargemaster and fee schedule revision and updates
• A reconciliation process to ensure that every chart is coded
• Physician and nursing workshops to foster improved documentation practices
• Monthly reports for each physician listing each record that is missing adequate documentation
• A revised fee schedule
• Monthly administrative reports
• Attention to Local Medical Review Policies (LMRP) for medical necessity
• Maintenance of an audit trail for accountability

A. MMR’s coding process includes the following steps:

1. On a daily basis, the hospital or physician group sends a copy of the daily log and copies of complete charts for each patient treated. Chart copies should include all emergency physician and nursing documentation as well as the patient demographic sheet for each patient encounter. MMR accepts copied, scanned or encrypted e-mail records.
2. MMR's check-in staff will compare the ED daily log with the charts that are received. The client is sent a list of missing or incomplete records that must be forwarded to our office for coding. This process ensures that all records are coded.
3. Within 48 to 72 hours of receipt of records, MMR's coders assign codes for each ED patient.
4. Codes are returned to the group via encrypted e-mail or electronic download, as desired by the client, for billing purposes.
5. On a monthly basis, MMR sends the client reports that will facilitate management of the practice. These reports include information on E/M and CPT code distributions, physician documentation deficiencies, ICD-9 code usage, turn-around-times, and more.

A. Yes. Should you need temporary help while your coding staff are out-or simply want to get caught up with your billing-MMR also offers short-term coding services to meet your changing workforce needs.

Q. Our group is considering outsourcing the facility coding for the Emergency Department. Why should we choose MMR?

A. With over two decades of specialization in coding for EDs, MMR has emerged as a nationally recognized authority in this area. Our certified coders, highly trained in the complex art of emergency medicine billing, understand our responsibility to stay abreast of changing rules and regulations in order to protect your physicians from unknowingly committing fraud and abuse. Through selective recruitment, complete compliance training, and ongoing education, we’ve cultivated a first-rate team of coding experts, each dedicated to producing the highest quality work product. In addition, MMR’s stringent compliance program, coupled with our practice of conducting random audits, ensures the integrity of our services.

Coding Compliance Audits

Q. Why does my group need compliance audits?

A. The complexities of ED coding can leave your practice vulnerable to lost revenue, inappropriate reimbursement, and worse, charges of fraud and abuse. In fact, the Office of the Inspector General (OIG) cites coding and billing as a specific risk area for physician practices today. By enabling you to isolate and remediate critical problems in your coding and billing methodologies, routine compliance audits can serve as an effective control for ensuring adherence to federal and state laws. This type of risk management can help you protect your providers and financial interests and ensure the long-term viability of your ED practice.

Q. Should my ED practice elect to have audits performed internally or by a company that specializes in this service?

A. MMR recommends that groups have an external baseline audit performed by a company specializing in compliance audits for the field of emergency medicine. An external audit provides an objective approach to determining whether problems exist in your coding and billing methodologies. Additionally, it provides a framework for remediating issues. Following a baseline audit, MMR recommends that coding be monitored internally on a monthly basis , with external audits performed quarterly, biannually or annually depending on the group’s unique strengths and weaknesses.

Q. What does a compliance audit involve?

A. During the auditing process, the group sends copies of random ED records along with the codes assigned to each chart. MMR's auditor then utilizes the CMS Documentation Guidelines to determine the correct Evaluation and Management (E/M) Level, CPT procedure codes and modifiers for each chart based on physician documentation of History, Physical and Medical Decision Making. This information is presented in a comprehensive report that includes the following information:

• The error and accuracy rates for E/M Level coding
• A list of each record in the sample, the codes assigned by the client's coders compared to those assigned by MMR's auditor, and MMR's rationale for different code assignments
• An assessment of whether physician documentation of History and Physical Examination supports the level of medical decision-making for each record in the sample Based upon this report, the practice can isolate problems and develop an action plan to remedy coding, documentation or billing problems.

A. A compliance audit by MMR provides answers to the following questions:

• Is our coding consistent with best practices?
• Are we correctly billing for professional and technical services?
• Is our CPT coding accurate?
• Are modifiers appropriately applied?
• Is our physician and nursing documentation adequate for coding and does it allow coders to assign E/M levels that accurately reflect the ED services provided?
• Is my ED’s facility assessment criteria appropriately developed and utilized? An external compliance audit is designed to present you with a clear picture of what your practice stands to lose as a result of flawed coding and billing procedures-and what can be gained by improving them. This process forms the basis for significantly reducing your liability, protecting your assets and enhancing your revenue potential.

A. MMR is a recognized leader in coding compliance for the field of emergency medicine. Having been retained by some of the largest ED physician groups and hospitals in the nation to provide coding and compliance audits, our organization has set a standard of excellence for this practice. Our own outstanding compliance program, perfected over two decades of experience, forms the basis for our auditing services.

Compliance Services

Q. What do your Compliance Services cover?

A. MMR's Compliance Services include the development and analysis of regulatory compliance programs, comprehensive risk assessment, and evaluation and monitoring of coding practices. Each of these services provides an additional layer of risk management for your hospital Emergency Department or physician group practice, helping you strike a balance between staying on the right side of compliance issues and collecting all legitimate revenue for your health care services.

Q. How can my ED practice benefit from MMR's Compliance Services?

A. In today's highly regulated environment, maintaining compliance in your everyday documentation and coding practices is vital to your organization’s survival. Through our Compliance Services, MMR offers you a variety of ways to implement quality assurance in your daily business operations. In doing so, we enable you to identify any issues that may be placing your practice and your providers at legal risk. Diligent risk management is paramount to avoiding consequences arising from charges of fraud and abuse. These consequences include monetary penalties, exclusion from federal insurance programs, or even imprisonment.

Revenue Cycle Consulting

Q. What is a Coding, Billing, and Revenue Analysis for coding companies, hospitals and physician groups?

A. A Coding, Billing and Revenue Analysis by MMR tracks ED coding and billing functions through the processes of patient registration, nursing and physician documentation, and coding and claim management in the billing office. The objective during this process, which includes a 2-day on-site visit to the client’s facilities, is to ensure the group’s coding and billing compliance and improve reimbursement for services rendered. Within three weeks following the final visit, MMR submits a detailed final report to the client. This report includes a summary of findings and recommendations encompassing the areas of compliance and coding, data collection, registration and billing.

Q. How has the outpatient Prospective Payment System (PPS) affected coding and billing for hospital Emergency Departments?

A. Prior to August 1, 2000, EDs charged for their services by billing a level of service (determined by criteria designated by each facility) along with the supplies, medications and ancillary services performed during a patient visit. The Centers for Medicare and Medicaid Services (CMS) designed the new Ambulatory Patient Classification (APC) system around the physician method of coding and billing. Hospitals are instructed to utilize Evaluation and Management (E/M) Levels 99281-99285 and 99291 to bill for the intensity of services administered to patients in the ED. CMS instructed each hospital outpatient area to develop its own unique criteria, called "E/M Level criteria or Nursing Assessment Criteria," for determining these levels of service. The criteria must reflect increasing intensity and be accurately and consistently applied in coding. Although most hospitals have put their best efforts into developing custom E/M Level criteria, the truth is that most EDs are operating with faulty criteria. As a result, patient visits are coded at levels that don’t accurately reflect the care provided by the ED team. Many hospitals today are losing significant revenue, and will continue to do so until their criteria is corrected and/or updated.

Q. How can MMR help my hospital with this issue?

A. MMR helps hospital EDs reduce revenue leakage and improve their bottom line through a comprehensive Facility Coding and Billing Assessment. The process is relatively simple and includes the following steps:

• The hospital sends copies of ED records from recent dates of service to MMR, including ED and consulting physician and nursing notes, the billing detail, and the UB-92 or bill for each chart. MMR also needs a copy of the hospital's Emergency Department Chargemaster and E/M Level criteria.
• MMR's auditor assigns E/M Levels and CPT/HCPCS codes for each chart in the sample. These codes are compared to those on the UB-92 or billing statement for each record.
• MMR prepares a report discussing the effectiveness of the hospital's unique E/M Level Criteria, accuracy of code and modifier assignment, and a revenue assessment reflecting the hospital's average patient charge compared to the average patient charge generated by MMR.

A. Coordination of the coding and billing process for a hospital Emergency Department is an arduous task, and requires coding, billing and clinical expertise for developing and utilizing E/M Level criteria. There are people who have an understanding of either the coding, billing or clinical piece of the process, but few hospitals have staff with a knowledge of the "big picture." This causes a breakdown in the system and can result in a compliance or revenue nightmare. CMS has indicated that hospitals will be held responsible for 1) developing E/M Level criteria that are reasonable and consistently used and 2) correctly utilizing the CPT/HCPCS codes that represent procedures performed in the Emergency Department. Most hospitals find that they have significant losses in charges as a result of faulty coding or billing procedures. In addition to determining coding and billing compliance, a Facility Coding and Billing Assessment by MMR provides a reimbursement analysis that is essential in this environment of declining healthcare dollars.

Coding Education

Q. My group has experienced coders who need an update on coding for emergency services. Does MMR offer instruction of this nature?

A. Yes. MMR offers instruction in both professional and facility coding, designed to help your coders stay one step ahead in the fast-changing specialty of emergency medicine. Our education sessions focus on providing your coding professionals with accurate and timely information as well as teaching them the practical skills necessary to document the patient visit with proficiency. Skills testing assures that your coding staff are proficient at the conclusion of MMR’s sessions.

Q. Is your coding education conducted in a classroom?

A. No; MMR’s training sessions are held conveniently on-site at your facility. Lessons are customized according to your staff’s experience and specific learning needs.

Q. What is covered during your professional coding training sessions?

A. Lessons are customized to accommodate your unique needs; however, in general, MMR can help enhance your coders’ knowledge of:

• Evaluation and Management (E/M) Levels including critical care and observation
• CPT procedure coding, including but not limited to surgical codes (including lacerations, I&D, orthopedic services, etc.) and coding for diagnostic interpretations
• Coding for teaching physicians
• Coding for mid-level providers
• Application of modifiers
• Collaborating with physicians to provide a feedback loop on coding and documentation
• Developing a quality assurance program for coders

A. Training is tailored to your staff’s learning needs; however, in general, MMR’s facility coding instruction covers the following topics:

• Overview of the Outpatient Prospective Payment System (OPPS) and Ambulatory Payment Classifications (APCs)
• Determining E/M Levels utilizing criteria developed by the hospital (MMR will provide the coder with a complete Emergency Department Chargemaster)
• Application of modifiers
• "Putting it all together in your facility" (how to coordinate documentation, coding and billing office efforts)
• Tip on effectively managing "hot spots" within your coding and billing applications
• Providing feedback to nurses and physicians
• Developing a quality assurance program for coders

A. For coders who have received training from MMR instructors, we offer optional audits conducted on a random sample of charts each month for the first three months. Following this initial period, three additional quarterly audits are performed. This is an excellent method of reinforcing the principles learned during the training session.