Operations Review
The Operations Review is designed to evaluate key departments’ charge capture, coding, billing and compliance processes. The review focuses on those departments that have the greatest impact on the hospital’s APC reimbursement. The review identifies specific actions for improving departmental operations and financial performance. The Operations Review is the first step in restoring profitability to hospitals needing turn around assistance.

Performance Improvement – Clinical Departments
Wellington works with individual clinical departments to improve their charge capture, documentation, coding, billing and compliance processes. Revisions to the department’s charge master, order entry screens or charge tickets, and staff education are performed for all departments by our clinical consultants. Additional services unique to specific departments are described below.

Emergency Department
Additional services for emergency departments include identification of payable procedures that are not currently coded, development of a visit classification system for assigning the technical component of a visit based upon non-physician staff interventions and resource usage, and protocols to streamline charging for procedures and supplies that reduce lost charges. These performance improvement methods have significantly increased the reimbursement for clients’ emergency departments.

Outpatient Clinics
Additional clinic-specific services include developing a consistent, objective system for assigning the E/M technical component across clinics based on non-physician interventions and resource usage as well as identifying additional payable procedures that are not coded currently. Our staff has used these approaches to address compliance concerns and improving reimbursement for academic medical centers and health systems with large numbers of medical, surgical and specialty clinics.

Oncology
Additional services for oncology include the appropriate reporting of pass-through drugs and devices, generic vs. brand name drugs and units of service as well as the development of E/M visit levels. Our staff has worked with many of the comprehensive cancer centers across the country to address both chemotherapy and radiation therapy issues.

Surgery and Endoscopy
For surgery and endoscopy departments, Wellington has developed charge capture protocols that improve the reporting of secondary and cancelled procedures as well as simplify charge entry of supplies. These specialty-specific techniques have resulted in increased reimbursement while reducing charge entry time.