Murer Consultants, Inc

PROVIDER-BASED CONSULTING

Murer Consultants has long been involved in helping hospitals and health systems optimize their operations – as well as their bottom lines – by utilizing provider-based status. In 2003, Murer Consultants, in conjunction with Commerce Clearing House (CCH), published their book “Understanding Provider-Based Status.” Since then, Murer’s team of consultants have guided many hospitals and health systems through the process of seeking provider-based status, from understanding and satisfying federal requirements to developing creative solutions to everyday operational challenges. Murer Consultants works closely with clients to evaluate the financial implications of provider-based status and to implement strategies that ensure full regulatory compliance.

Murer Consultants offers clients a broad and unique perspective, having consulted on provider-based projects in more than 42 states. Members of the Murer team have experience interacting with fiscal intermediaries across the country and closely monitor patterns, regulatory changes and other emerging developments.

During the course of a typical provider-based project, Murer evaluates the feasibility of changing existing Medicare Providers to provider-based entities in order to identify the regulatory, legal, financial, organizational and political ramifications of such a transition. This in-depth analysis focuses on financial impact, regulatory compliance, site criteria and organizational structure. Murer will work with designated hospital or health system staff to gather appropriate data to complete such comparative analysis, which is presented as a work plan and assessment in a formal presentation at the conclusion of the project. Murer will also initiate preparation of all necessary filings and act as the primary liaison between the client and various government agencies and administrative contractors. 

Utilizing provider-based status can yield significant operational benefits for hospitals and health systems. Murer Consultants can help clients achieve those outcomes by leveraging a wealth of experience, a detailed understanding of relevant regulations and operational savvy.

For more information or to receive a quote for your situation, please contact Michael Murer at (815) 727-3355 or via email at mmurer@murer.com.

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PHYSICIAN CODING AUDIT SERVICES

Murer provides consulting services to evaluate and assess compliance with federal and state healthcare programs and related regulations to ensure appropriate and accurate physician coding for Medicare and Medicaid billing.

Specifically, Murer will review a random closed medical record sampling for each practitioner requested and offers on-site visit availability with expert physician coding affiliates to evaluate and assess the following items:

• Bills are accurately coded and accurately reflect the services provided (as documented in the medical records);
• Documentation is being completed correctly in accordance with" Documentation Guidelines for Evaluation and Management Coding" and "Official Coding Guidelines for ICD-9-CM";
• All services are being captured to insure accurate reimbursement for all physicians;
• Services or items provided are reasonable and necessary;
• Provision of advance beneficiary notices as applicable;
• Occurrence of double billing resulting in duplicative payment;
• Occurrence of billing for non-covered services as if covered;
• Occurrence of misuse of provider identification numbers, which results in improper billing;
• Occurrence of unbundling (billing for each component of the service instead of billing or using an all-inclusive code);
• Occurrence of failure to properly use coding modifiers;
• Occurrence of clustering (coding/charging one or two middle levels of services codes exclusively, under the philosophy that some will be higher, some lower, and the charges will average out over an extended period of time);
• Occurrence of upcoding the level of service provided;
• Physician incentive practices;
• EMTALA compliance;
• Professional Courtesy;
• Retention of coding compliance records; and
• Establishment of an on-going continuing physician coding compliance program.

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