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- SMM Coding Services:
SMM will provide coding services including CPT-4
procedure codes, CPT-4 modifiers, and ICD-9
diagnosis codes. All coding will address compliance
with the coding and billing guidelines established
by the Centers for Medicare and Medicaid Services
(CMS), the American Medical Association (AMA), and
with the Documentation Standards for Radiological
Studies as developed by the American College of
Radiology (ACR). CMS’ National Correct Coding
Initiative
(NCCI)
edits will also be referenced in coding these
services, to assure that unbundling does not occur. SMM
will assign codes based solely on the specific
documented information contained within the
typewritten radiology report supplied by Client.
Coding will be performed only by SMM employees
currently maintaining a national coding
certification and having diagnostic and
interventional radiology coding experience. Client will be consulted
regarding missing, conflicting, or ambiguous
documentation within the report, in accordance with SMM’s Compliance Plan.
- Process
Client shall provide SMM with typewritten radiology
reports via paper or electronic means. All paper
reports shall be shipped directly to SMM’s office
via a national delivery service, where they will be
coded and returned to Client via a national delivery
service within an agreed upon time frame. Client is
responsible for all delivery costs. All
electronically submitted reports will be coded and
returned to Client via same electronic means within
an agreed upon time frame. Client is responsible for
all costs associated with providing SMM with
electronic access to their reports. Any reports not
containing sufficient information regarding the
medical necessity of the study or sufficient
documentation of the study itself will be returned
to Client uncoded, in accordance with SMM’s
Compliance Plan.
- Compliance
SMM will code procedures in accordance with all
applicable federal rules, regulations and guidance,
as stated above. SMM reserves the right to comply
with the recommendations of the Office of Inspector
General in its Compliance Guidance for Third Party
Billing Companies. SMM will perform all coding
services in accordance with SMM’s Compliance Plan.
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