Feb 9 2010
Picis today announced the immediate availability of an enhancement to its Picis LYNX C/Point® revenue management solution designed specifically for hospital-owned chemotherapy clinics.
LYNX C/Point mitigates the risk of payer and recovery audit contractor (RAC) penalties by providing consistent and compliant charging and revenue capture support for oncology intravenous (IV) clinic administration services, which are part of an oncology patient’s routine treatment. These costly, but undervalued services are under greater scrutiny by the Office of Inspector General because of complex coding rules for infusion and injection procedures. Together with Picis’ LYNX E/Point® solution, C/Point now provides clinics with the tools to calculate accurate and defensible services for their entire outpatient populations, including chemotherapy infusion centers — meeting guidelines issued by the Centers for Medicare and Medicaid Services (CMS), and providing financial predictability of oncology charges that reflect services rendered to patients.
“Oncology IV therapy is even more expensive than routine IV and hydration services, and even more challenging to code”
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Organizations, particularly managers of clinics, health information and compliance, face the challenge of managing their charging practices across geographically-dispersed chemotherapy clinics. As a result, they must be confident that methodologies used for calculating chemotherapy infusion services meet Outpatient Prospective Payment System (OPPS) Guidelines, and provide a consistent approach to charging practices across all facilities. C/Point and E/Point are centrally-hosted revenue management solutions that are easy to deploy and use, and share the same proven LYNX charging algorithm used to calculate the maximum allowable Current Procedural Terminology (CPT) code in more than 600 hospitals nationwide.
IV coding rules in general are considered very complex, and have been targeted by RAC auditors due to the frequency of payment errors that can arise from noncompliant procedure coding.
“Oncology IV therapy is even more expensive than routine IV and hydration services, and even more challenging to code,” says Mike DeTolla, Senior Vice President of Revenue Management Solutions of LYNX. “As a result, healthcare organizations frequently submit only chemotherapy medication fees, entirely omitting the facility visit-level charge and the respective concurrent and sequential administration services such as flushing, hydration, rehydration and bag-changing charges on bills. This can result in incomplete reporting, significant loss of revenue and an increased risk of audit. Accordingly, we believed the situation warranted a new dedicated feature in C/Point to promote the accuracy of oncology IV coding.”
Beyond the infusion capability, chemotherapy clinics also have access to the LYNX Evaluation and Management (E/M) proprietary and proven coding methodology that spans hospital-owned clinics as well as the emergency department (ED). Using an acuity-based methodology, Picis’ LYNX™ revenue management solutions are designed to produce consistent, compliant and accurate facility visit level charges for services provided and resources used. This approach assists the hospital with financial predictability and a secure audit defense.
Picis LYNX E/Point and C/Point solutions have captured charges for more than 21 million patient visits annually in more than 600 hospitals throughout North America. LYNX revenue management solutions help emergency and other outpatient care providers automatically capture charges for care provided, consistently calculate the E/M facility visit level, often with significant financial returns, better prepare against audits with proven, defensible charges and better integrate the patient care, charging and coding process.
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