In compliance with Medicare & Medicaid regulations
OR/Surgery Case Leveling
Organizing and protecting accuracy of procedures.
What is Case Leveling?
Case Leveling is the grouping of cases into levels to reflect accuracy of procedures performed with staff involvement and resources required.
How does Case Leveling apply?
A small hospital with minor surgical procedures will usually be Case Levels 1 to 3 while a large hospital with a full spectrum of surgical procedures will have Case Levels 1 to 6.
Goals & Objectives
Classify every surgical procedure into 1 to 6 Case Levels and establish a time based charge for each Case Level. Next, implement Case Leveling program with full OR staff acceptance.
Our OR/Surgical Case Leveling project will accomplish the following objectives:
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Decide if Case Leveling program will be utilized in OR and GI or just in OR.
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Decide if Case Leveling will be a mirror image for Anesthesia time charging.
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Decide if Case Leveling will be a mirror image for PACU/Recovery Room time charging.
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Obtain full listing of all procedures performed in OR for past two years with usage by Inpatient and Outpatient
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List top 100 procedures by usage
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Assignment of all surgical procedures to a case level
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Group all procedures by Case Level
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Obtain approval of OR Department of all Case Level assignments
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Design form of each Case Level group for charging assistance
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Establish time based charges for each Case Level in OR, Anesthesia and PACU. If Case Leveling is not utilized in Anesthesia and PACU then review current charge method and make recommendations as needed.
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Design the educational materials with testing material as needed and obtain hospital approval of materials
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Provide educational sessions for OR staff of program and insure all required staff attends sessions, pass written and oral test
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Test OR staff on selection of Case Level and Time Based charging
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Implement program, MedCompliance staff member will be on site to assist and guide
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Review 100% of first 100 patients if Case Level was accurately selected and charge is correct
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Schedule follow-up webinars or classroom sessions as needed
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Provide re-occurring educational sessions for staff that are new employees or missed initial session or failed the written and oral test