Potential Benefits to You
  • Better knowledge of facility’s charges, revenues, and expenses
  • Improved billing process - billing for each service you are entitled
  • Improved process of tracking denials and speeds claims review
  • Better communication and coordination among departments
  • Knowledge of correct usage of modifiers
  • Improved UB-92 data integrity
  • Better understanding of the OPPS rules and guidelines
  • Identifies patterns and billing problems
  • Better understanding of the Correct Coding Initiative (CCI) edits

APC Analysis

Under the Centers for Medicare and Medicaid Services’ (CMS) outpatient prospective payment system (OPPS), facilities are challenged to report procedures compliantly and accurately to receive correct reimbursement for all services provided. Most hospitals have recognized the need to have an external review function to monitor payment, coding and billing accuracy.

BKD Health Care Group’s APC analysis assesses a facility’s claims submission processes, including submission of procedure CPT/HCPCS codes, revenue codes, as well as data integrity, including the charge entry process from multiple ancillary departments and the HIM coding functionality. Our APC analysis includes the following procedures:

  • Assess the facility’s coding and billing processes, including review of the UB-92 claim form
  • Assess the facility’s documentation for accurate coding
  • Assess documentation for additional procedures and/or services that are provided but not billed
  • Assess documentation to determine level of compliance with proper coding procedures
  • Compare billed charges to the remittance advice
  • Assess appropriate usage of modifiers
Request a call from a BKD advisor

For More Information

Contact your BKD advisor or:

R. Scott Vaughn
800.581.4290