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Explanation of Churchill Consulting Financial Products & Services

Table - Listing Financial Product & Service Options with Product ID

Please click on the description to navigate, or scroll down.

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# Description of Product or Service Time
F1 AUDIT: Technical Review Only-10-Chart Audit: 77000 Codes 6.5 hrs
F2 AUDIT: Professional Review Only: 10 Chart Audit 6.5 hrs
F3 AUDIT: Freestanding Global 10 Chart Audit 8 hrs
F3A AUDIT: Combined Technical & Professional 10 Chart Audit ((Requires same coding & DOS) 8 hrs
F3B AUDIT: Combined Technial & Professional 10 Chart Audit (Coding Done Independently) 10 hrs
F4 AUDIT: In Office Focused Audit (Single review/technical or professional) Not Required
F4A AUDIT: Remote Limited Not Required
F5 AUDIT: On-Site Audit 8 hrs
F6 AUDIT: On-Site Code Review 8 hrs
F7-1 SEMINAR: Course P: Coding for Physicians  2 hrs
F7-2 SEMINAR: Build A Case – Document A Case  1 hour 30 mins
F7-3 SEMINAR: Course T: Coding the Diagnostic & Technical Only Codes in Radiation Oncology  1 hr 10 mins
F7-4 SEMINAR: Simulation  1 hr
F7-5 SEMINAR: Isodose Planning-Devices Advanced Technologies (3D/IMRT)  2 hrs 30 min
F7-6 SEMINAR:Coding Stereotactic Radiosurgery  2 hrs
F7-7 SEMINAR: Brachytherapy  2 hrs
F7-8 SEMINAR: IGRT  1 hr
F8 Compliance Plan Client Worksheet
F9 DIRECTREES® (Coding Help Application) NA: User's Guide
F10 SEQUOIA Annual Update Plan for DIRECTREES® NA: User's Guide
F11 Comprehensive Dynamic EMR Forms Package NA
F12 Annual License: Comprehensive Dynamic EMR Forms Package NA
F13 DIRECTREES® (Coding Help Application) with Dynamic Forms  
F18 Newsletter  
F14 On-Site Day Rate  
F16 Practice Pro-Forma  
F17 Customized Pro-Formas  

Click here to jump to the Price List for cost of services.

Total financial packages are available that will reduce the total cost while providing you with the services required to address all billing needs in your department.

Additional services include customized pro-formas, such as Iodine Seed Pro-forma and 20-Diagnosis Pro-forma, etc. Contact Churchill for more information in regards to customized pro-forma services.

Prices are subject to change. Please contact Hassan Megahy of Churchill Consulting (CruxQS) at (618) 616-6570 to confirm current rates.

FINANCIAL PROGRAM OPTIONS - Identifying Current Billing Accuracy


The following is a summary of services included with the four audit options. Note that the ‘global’ audit option F3 is listed.


Contract Charge $250 per hr $5,000 per day $7,500 $16,500
Number of Charts Audited ~ Per Contract Average 5 10 10
Code by Code Findings Yes Yes Yes Yes
Type of Comment per Code Limited drop down comments Limited drop down comments Limited short comment Detailed full subjective
Subjective Summary per Chart No No No Yes
Subjective Summary per Chart per Code No No No Yes
Financial Impact per Chart No No Yes Yes
Overall Audit Financial Impact No No Yes Yes
Code by Code Impact No No No Yes
Net Impact Incorrect Codes No No No Yes
Net Impact Credit/Adjust Codes No No No Yes
Net Impact Missed Codes No No No Yes
Net Impact Potential Codes No No No Yes
Percent error rate per chart No No No Yes
Percent error rate per code No No No Yes
Detailed Summary: Recommendations No No Yes Yes
Executive Summary On-Site No Yes: 1 Hour No Yes: 8 Hours
Material Required Prior to Audit Coding Summary; EMR access Coding Summary Coding Summary & Full Chart Coding Summary & Full Chart
Office Data Entry 20 minutes per chart 30 minutes per chart 40 minutes per chart 60 minutes per chart
Audit Process Time 60 minutes per chart 90 minutes per chart 3 hours per chart 4-6 hours per chart
Final Audit Report Preparation (Office) 10 minutes per chart 6 hours 8 hours 20+ hours
Final Report (PDF) Size Average 3 pages per chart Average 75 pages Average 150 pages Average 300+ pages

Service F1 - TECHNICAL Coding: 10 Chart Audit with On-Site Executive Summary

Service F1: AUDIT - Technical Comprehensive Audit Fee: $13,500

  • This price reflects technical ONLY based audit.
  • See F2 for a professional only audit.
  • See F3 for freestanding audit.
  • Note: Pricing includes one course per chart audited. Combined modality charts (i.e., EBRT & HDR, etc.) will be limited to two. An additional fee of $500 per chart will be charged for combined modality charts submitted for review in excess of two.

Chart audits are the logical place to start when evaluating your organization’s current coding practice and an invaluable tool in determining charge capture efficiency. This comprehensive TECHNICAL ONLY chart audit option includes a complete review of the TECHNICAL component for ALL 77000 series CPT codes for each of the ten charts audited.
(See F3 for the combined TECHNICAL-PROFESSIONAL audit option).

INDIVIDUAL CHARTS: A subjective report is provided for each of the ten charts reviewed. Each code reported, in order of encounter, is reviewed. The chart review section of the report will include narrative findings for each chart, a spreadsheet presentation of the coding findings, and graphs of the Commercial and Medicare impact (per chart).

CODE-BY-CODE: The overall coding accuracy will also be calculated for each chart and for each code, adding important information to the overall financial impact summary. The level of accuracy will be presented by percentage, providing quantitative findings to compare future audits too.

FINANCIAL IMPACT: The financial impact will be graphical exhibited based on actual findings and represented with potential coding, demonstrating the optimal revenue opportunity for your organization.

EXECUTIVE SUMMARY REPORT: The final executive summary report, which is provided to the client in electronic format via PDF, is presented on-site during the ‘on-site executive session’. The final report includes all subjective findings, complimented by findings presented via spreadsheet and graphically. The final report includes three (3) sections.

  • Section one (1) provides the summary of all compiled findings
  • Section two (2) includes the individual chart findings
  • Section three (3) includes the code-by-code findings

The chart audit review process requires that your current charge master and certain portions of the ten charts be sent to Churchill’s office for evaluation and database entry. Churchill will perform a complete code review, examining each chart for completeness, proper billing processes, and documentation. The audit will determine if your billing is consistent while analyzing your current billing practice. Each code reported will be individually reviewed and will include a color-coded narrative summary. The color-coding will correspond to the graphs and spreadsheet summaries in the accompanying financial impact report. Codes will be rated as correct, incorrect, code level incorrect, missed, or potential; and that information will be used to determine the financial impact of the findings.

An estimated financial impact summary will be included in the report. In the past (prior to advanced technologies) we found that most centers missed an average of 20% - 35% of allowable charges. Currently, we find that an average of ~ 45% of codes or level of code are reported INCORRECTLY, placing the organization at risk. An audit is paramount in identifying your organization’s area of risk (exposure).

Recommendations for coding will only be made for services that have been provided with complete substantiated documentation. Items that are currently billed that do not have proper documentation in the patient’s medical record will be identified as ‘credits’ in the final chart summary, as the medical record must support all coding.

10-Chart Audit Report Format

Each chart review results in the following:

  1. A detailed narrative report for each chart, usually 3-6 pages.
  2. Every procedure reported is examined for appropriateness. The actual coding is compared to the expected coding.
  3. Discrepancies in coding are listed in categories (credit (RISK), credit-level-adjust (RISK), missed and potential.
  4. Spreadsheet summary of actual coding vs. expected coding depicting the financial impact. This report calculates the percentage of codes adjusted (in the four categories listed above). This impact is critical, as the net coding error may be zero, while a large percentage of codes may have been adjusted, all of which represent RISK.
  5. Spreadsheet summary demonstrating the financial impact of the credits, adjustments and potential coding. Financial impact reports are completed for the Medicare fee schedule and your commercial fee schedule.
  6. A detailed written executive summary report, provided electronically via PDF file, will summarize the overall findings for each code, provide recommendations for proper code utilization, and include documentation requirements and recommendations to improve the processes and increase revenue.
  7. Summary graphs will be included that will demonstrate the financial impact by diagnoses and by Medicare and Commercial fee schedules.

On-Site Executive Summary

The on-site executive summary is not scheduled until all materials have been received by Churchill and reviewed for completeness. The on-site executive summary will then be scheduled in Churchill’s next available date in our calendar queue. Some billing issues or questions may need to be confirmed with the physician or physics staff when first arriving on-site. During the executive summary, the financial findings are presented to the leaders, on a 'need to know basis'. The financial impact presentation will require approximately 90 minutes. Regulatory requirements will be discussed in detail.

The remaining five hours will be spent presenting the narrative and coding findings for each chart. All available staff members should participate in this presentation. This presentation will include a detailed review of coding errors, recommendations for improved documentation. Churchill. often includes complimentary forms in order to provide methodologies for improved documentation.

Sending Chart Information

When sending the billing summary, if you have the capability of grouping your charges per procedure, such as all 77300 charges listed in order of date of service, it is easier for us. Be sure that the CPT and description of the service is included in the printed billing summary. A surcharge of $1,000 is added if charge summaries are sent with only facility codes rather than CPT codes. The total quantity must be listed as well as the date of service.

Although we welcome your complicated charts, choosing charts that are the most representative of your standard treatment regimens will provide a greater degree of statistical relevance to the findings. Pricing includes one course per chart audited. Combined modality charts (i.e., EBRT & HDR, etc.) will be limited to two. An additional fee of $500 per chart will be charged for combined modality charts submitted for review in excess of two.

If you choose this option, the following information should be copied and sent to CC-CQS:

  • Professional Commercial Charge Master (Option F3)
  • Technical Commercial Charge Master (Option F1)
  • (If you are billing globally, please send the global charge master)If you have contracted for the Professional and Technical Combined Audit (F3) please send both charge masters.
  • Coding summary for the entire course of therapy-both professional and technical (requires CPT® Code not facility code)
  • Quantity of Code(s) Posted
  • Date of Service/Date Posted
  • Consultation/H&P
  • Clinical Treatment Planning Note
  • Weekly Progress Notes
  • Medical Necessity Forms or Notes
  • All Physician Simulation Procedure Notes
  • Technical Simulation Set-Up Notes
  • Physician Prescription for Treatment Regimen
  • Copy of the Graphical Treatment Record (each chart)
  • Isodose Plan(s), BEVs, Irregs, All Hand Calculations
  • Copies of all special dosimetry orders and reports
  • Copies of all DRRS (printed or jpeg; no films necessary)
  • Copies of the Treatment Photos
  • Documentation for weekly physics services
  • Any special physics consultations
  • Treatment Summary Note

The diagnoses that represent the widest range of billing codes include:

  1. metastatic - any area
  2. head and neck –IMRT planning with multiple PTVs
  3. breast with supraclav -with electron boost (standard planning or 3D)
  4. prostate - IMRT
  5. prostate EBRT &implant
  6. GYN with EBRT &with brachytherapy (implant or HDR)
  7. lung - 3D or IMRT
  8. curative brain – 3D, IMRT and/or SRT
  9. IMRT case of your choice
  10. Advanced technology regimen, i.e., SRS/SBRT

Please randomly choose ten (10) chart samples from the list above. (One course of therapy includes one entire treatment course. If second non-concurrent areas were treated, that would be considered a second chart, i.e., lung in June - brain in September.) The diagnoses listed above will provide us with a representation of the majority of CPT codes that are used in radiation oncology. If you have multiple physicians in the department, you may consider sending the same diagnosis for two physicians to allow us to review the consistencies within the department. For example, you may choose to send two breast cases or two head and neck cases. Please be sure to include at least one 3D regimen and one IMRT regimen if you provide these services. If your organization provides brachytherapy procedures, please include a chart for each type of service, i.e., prostate with implant, GYN with HDR, MammoSite, etc.

Service F2: AUDIT - Professional Coding 10 Chart Audit

Fee: $13,500

This comprehensive PROFESSIONAL ONLY chart audit option includes a complete review of the PROFESSIONAL component for ALL 77000 series CPT codes for each of the ten charts audited. In addition, all professional only codes will be reviewed. The professional only codes include the Evaluation & Management services (99000 series codes), physician treatment planning (77261-77263) and weekly physician management charges (77427, 77431, and 77432). Please see F1 for presentation and report format.
(See F3A for the combined technical-professional audit option)

99201-99255 - E/M: The corresponding consultation reports for the charts submitted for the technical review will be examined in detail. The mandated elements for E/M (chief complaint, HPI, ROS, PFSH, physical exam, and level of decision-making) will be examined for appropriate documentation and coding level. A complete narrative will result summarizing all findings. Recommendations for documentation and/or code selection will be made.

77427 - Weekly Management:The weekly management for the entire treatment regimen will be reviewed. Findings will be summarized and recommendations will be made as necessary.

77261-77263 - Physician Clinical Treatment Planning:The physician clinical treatment planning is a cognitive process, but documentation must be available or implied by the work done to substantiate the level chosen. All charts will be reviewed to determine if the proper level was chosen and if appropriate documentation is available.

Services F3: AUDIT - Global 10 Chart Audit

Fee: $16,500

This is the chart audit option for freestanding centers that are reporting globally. Please see F1 for presentation and report format.

Please see service F3A if your freestanding center is reporting Part A and Part B separately and separte reports are required.

Service F3A: AUDIT - Combined T & P: 10 Chart Audit (Same coding & DOS)

Fee: $17,500

This is the chart audit option for centers who wish to have a combined technical/professional audit who bill the same codes on the same data of service. Although separate reports will be completed for technical and professional, the subjective findings for the individual charts will be the same. The financial findings (report and on-site presentation) will be separate.
Please see F1 for presentation and report format.

Service F3B: AUDIT - Combined T & P: 10 Chart Audit (Coding Done Independently)

Fee: $20,000

This is the chart audit option for centers who wish to have a combined technical/professional audit but bill independently. This option applies for all joint audits (technical & professional) that have different procedures and/or different dates of services reported for the same procedures. Although separate reports will be completed for technical and professional, the subjective findings for the individual charts with the inconsistencies (high area of risk if different DOS or code is reported for the same procedure) will be the same. The financial findings (report and on-site presentation) will be separate. Please see F1 for presentation and report format.

Service F4: AUDIT - In-Office Focused Audit

Fee: $7,500

In-Office Short (Focused) Audit

This type of audit is only recommended for clients who have already had a complete audit and staff education. This level of audit may be considered for your annual audit to ensure that you "maintain the gain" and continue to code correctly. As with the Comprehensive Audit, ten charts must be copied and sent to CC-CQS for review. The Comprehensive Audit provides a full narrative for every code. The Focused Audit only includes a narrative for those codes that were reported incorrectly or if the required documentation is missing or inadequate. The final report will demonstrate the coding levels posted compared to the coding levels expected.

This report DOES NOT include the multiple levels of adjustment (credit, credit level-adjust, missed, potential) that are included in the Comprehensive audit. Only the net coding outcome is presented, although the narrative data will include a summary of the corrections. For example, if you report a simple simulation followed by a complex simulation, and the medical record demonstrates that the initial simulation was complex, followed by a block verification simulation (simple), the net outcome will be zero. A financial impact report will be completed for each chart as well as the overall financial impact of the ten charts combined.

Note: The $7,500 fee reflects one provider level of charging, i.e., freestanding center or hospital OPPS. An additional fee of $2,500 will be charged to complete a corresponding report for the physician component if contracted by the hospital, or visa versa.

An in-office focused audit follows the same format as the on-site audit, utilizing the same program and resulting in the same report, but 10 charts are guaranteed.

Service F4A: AUDIT – Remote Limited

Fee: $250 per hour

Remote Limited Audit

Ongoing auditing of charges will typically yield improved claims management processes, cash flow and compliance with applicable laws and regulations. By subscribing to regularly scheduled audits, specific coding issues that may recur in similar claims submissions will be identified. Careful pre-submission monitoring and review of these similar claims will safeguard against errors that could result in a claim denial.

A remote billing audit will be performed by Churchill Consulting to ensure that codes are appropriately reported according to CPT guidelines and conventions and carrier policies.

Two types and two levels of remote limited audit services are offered.

Options include

  • Coding review only, prospective audit
  • Coding review only, retrospective audit
  • Coding and documentation review, prospective audit
  • Coding and documentation review, retrospective audit

To conduct this type of audit, coding summaries will be exported to a dedicated audit program created by CC-CQS via excel software application. The imported coding summary shall include the DOS, CPT code (with library description), quantity, technical and/or professional component, and modifier.

CC-CQS will subsequently enter a brief comment on the accuracy of each entry. Discrepancies, errors, and/or comments will be entered under a comment section. For each category reviewed, findings will be indicated by use of a drop-down selection, and that selection will contain limited descriptions, such as yes, no, available, not available, NA, etc. for findings in regards to the appropriateness in each category reviewed. Short subjective finding will be added as necessary.

This audit process will be limited to the above described format; no financial impact is calculated, with findings being reported per chart reviewed.

Service F5: AUDIT - Coding Charts On-Site

Fee: $5,000

On-Site Audit

An on-site audit provides you with eight hours on site and results in the review of approximately four-six charts, depending on the complexity of the charts selected. It is in your best interest to review charts that are representative of your standard treatment regimens. Extremely complex charts require addition time and the on-site audit is time dependent. The audit process is performed during a 7-˝ hour time frame, followed by a 30-minute discussion of findings.

The total number of charts reviewed varies, based on the complexity of the charts submitted. If the executive summary exceeds the eight hours, the hourly rate will go into effect.

On-Site Report & Findings Format

An excel program is used to enter and to present the findings. Actual billing (which we request to be sent prior to arrival) is entered into the program. Charts are then reviewed for actual coding and the data is entered into the program. All coding is then compared.

A comment section next to each code references comments on findings. Statements will consist of OK if findings are correct. Other comments will include the reason found for the discrepancy in findings.

Final Report Format

A final report is generated, that is a printed copy of the spreadsheet with associated comments. Depending on the complexity of the charts reviewed, 4-6 charts are usually completed in the time period provided during an on-site audit. No electronic materials are provided.

Cost On-Site Audit

The cost is $5,000 each day of audit, plus travel. You can contract for seminar training on consecuative hours/day at the reduced rate of $3,500 (each additional day of training).

Service F6: AUDIT - Reviewing Coding Summaries On-Site

Fee: $5,000

On-Site Coding Review

An on-site coding review audit provides you with eight hours on site and results in the review of approximately twenty five (25) coding summaries per day. The coding audit process is performed during a 7-˝ hour time frame, followed by a 30-minute discussion of findings.

This review is limited to the review of coding summaries; the patient's medical records are not reviewed. Client shall provide CC-CQS the coding summaries prior to arrival in electron format. CC-CQS will review each code and code quantity that was reported and utilize dropdown selections to comment on the codes that were billed.

The beauty of this level of review is that if auditor finds multiple errors, discrepancies, or areas of high risk, the level of review can be changed to include the review of the patient's medical record at the same day rate.

On-Site Report & Findings Format

An excel program is used to enter and to present the findings. Actual billing (which we require be sent prior to on-site code summary audit) is entered into a customized program. The coding review process is conducted on-site.

A comment section next to each code references comments on findings. Statements will consist of OK if findings are correct. Other comments will include the reason found for the discrepancy in findings.

Final Report Format

A final report is generated, which is an electronically printed copy of the spreadsheet in PDF format.

Cost On-Site Code Review

The cost is $5,000 for the each day plus travel. You can contract for seminar training on consecutive hours/day at the reduced rate of $3,500 (each additional day of training). Just think, you can have fifty or more coding summaries reviewed in two days!



Click SEMINAR to navigate to the seminar section, which provides complete details in regard to all available seminars.


  • Seminar rates are based on an 8 hour ‘on-site day’, charged at the rate of $4,000 for day one. A day provides for six (6) hours of directed training. Simply select the seminar topic(s) that fits your needs.
  • Seminars scheduled in association with chart audits (on current days with the on-site executive summary) will be discounted by $1,000, resulting in a $3,000 per ‘day’ seminar rate.
  • Rates include handouts for up to eight (8) attendees. A nominal fee of $35 per person (within the organization) will be charged for handouts for additional attendees.
  • Seminar selections exceeding the initial day one criteria listed above, will be charged at the rate of $3,000 per ‘day’ or $400 per additional hour of seminar time.
  • Webinars may be scheduled and are charged at $400 per hour of webinar time.


If any of theses seminars are scheduled concurrently following a chart audit during the same on-site visit, the fee(s) for the courses will be discounted. Outside attendees will be charged in addition to organization’s seminar fee.

All seminars are conducted via "Power Point". If notified, CC-CQS can supply the overhead projection system.

Information is directed to radiation oncologists, physicists, dosimetrists, radiation therapists and billing personnel who are interested in coding accurately. The standard CPT® codes reported in radiation therapy are discussed in depth. Discussion includes the proper usage and various levels for each code category, required documentation and utilization guidelines.

Reduced Rate: Multiple Seminars (F6 – F7-1:F7-8) Scheduled Concurrently

Service F8 - Compliance Plan

Fee: Customized- $7,500

Fee: Non- Customized - $5,000

This product is licensed per address. This is the perfect tool for those organizations who have multiple centers in establishing corporate documentation and coding guidelines. One product deliverable is included.

Fee: Additional Address(s) - $1,000 per address

The Compliance Plan is an integral part of the organization's comprehensive compliance program and demonstrates the commitment to honest and responsible corporate conduct by demonstrating a good faith effort and commitment to ensuring and promoting integrity. Compliance programs help to fulfill an organization's legal duty to refrain from submitting false or inaccurate claims or cost information to the Federal health care programs.

The single biggest risk area is the preparation and submission of claims or other requests for payment from the Federal health care programs. It is axiomatic that all claims and requests for reimbursement from the Federal health care programs—and all documentation supporting such claims or requests—must be complete and accurate and must reflect reasonable and necessary services ordered by an appropriately licensed medical professional who is a participating provider in the health care program from which the individual or entity is seeking reimbursement.

When submitting supporting documentation for a claim upon request, the information may not be supplemented [unless a clerical error can be demonstrated]. It is imperative that the organization/department knows the exact documentation that is required to support each service. This may include orders as well as procedure documentation. Churchill's Compliance Plan provides definitive documentation and coding guidelines to ensure compliance. Although there may be a corporate level Compliance Plan that addresses the requirements stipulated by the OIG, such as employee education, anti-kickback, reporting of false claims, etc., this unique product provides you with the actual guidelines to follow for documentation and reporting services in your department or center.

Customized Compliance Plan:

To begin the customization process, a worksheet will be provided to the client that outlines standard oncology procedures, sequenced by patient encounter, coupled with the appropriate code categories. The worksheet defines which procedures require orders and what documentation is required to support a claim. Upon interview and/or completion of the worksheet, the document name(s) will be identified for orders and procedure documentation. Additionally, the platform will be defined where the document originates (EMR vs. EHR), and where the document resides in your system.

Utilizing this information, a Compliance Plan will be customized to reflect your exact documentation processes, responsible person(s) for completing each level of documentation, date of service for reporting services, and code level [with quantities as appropriate] that may be reported.

Churchill Consulting also offers a dynamic forms package, which will be highly effective in the organization's transition to the paperless environment. [Forms are not included with the Compliance Plan.]

Following the completion of the worksheet, the customized Compliance Plan requires approximately four hours interview time (teleconference and/or webcast) to discuss and further define current documentation guidelines. Recommendations will be made as required.

The final product is a comprehensive Compliance Plan document provided in electronic format via PDF. The Plan will include coding guidelines, documentation guidelines and will define the location and names of all documentation processes for your organization. The customized Compliance Plan will include the organization's LCD policies in the addendum section, thereby ensuring that Carrier stipulations for coding and documentation are followed. As each code group is presented in the Plan, information will include code levels – utilization guidelines - code quantities, the date of service reported, supervision requirement, and any other pertinent information in regards to that code or code group. An addendum section will include samples of all forms [orders and documents] currently used, with hyperlinks within the main body of the document to the corresponding forms. This provides a perfect roadmap to the documentation process and reference tool to use to ensure that all appropriate documentation is provided to support claim requests.

As a Compliance Plan is a dynamic process, the original 'word' document is also provided to allow the client to update information and process changes as they occur. Churchill Consulting is available for additional customization and updates – billed separately.

Non-Customized Compliance Plan:

Client will be provided with a sample compiled Compliance Plan in PDF format [without forms] and the various document sections that are included in the Plan, in Microsoft Word format. Client must have a licensed version of Microsoft Word, software is not provided. Client will be responsible for customizing the Word documents, converting all sections to PDF, entering forms in the addendum section, , compiling all documents, and adding hyperlinks within the document.

Service F9: DIRECTREES® (Coding Help Application Program)

Primary License Fee: $12,500 (*Initial license Includes up to 15 Users in this fee)
Billing Company License Fee: $25,000

*Note: Licensing for the DIRECTREES® application is address specific.

Satellite licenses, at a discounted rate, are available for those organizations who ‘share staffing’. A License is required ‘per address’


Click here to launch a demo version of the DIRECTREES® Coding Help Application. You will be requested to completed a form for contact, which will be followed by an End User License Agreement (EULA) screen. Please scroll to the bottom of the EULA and select 'accept' to launch a demo program. To return to our web page, simply click on the logo in the upper right hand corner.

Please contact CC-CQS by clicking here if you have any questions or if you wish to order the DIRECTREES® program.


Churchill Consulting, A new Crux Quality Solutions Company. (CC-CQS) created a copyrighted product in 1992 that was customized for each client and provided in paper format known as “Directory-Trees.” The ‘Trees’ provided concise coding summaries and documentation instructions for various treatment regimens. This product was the foundation for the current browser-based DIRECTREES®.


DIRECTREES® is a now a powerful browser-based online help tool, providing the most sophisticated coding and documentation assistance in radiation oncology. Our software is simple to deploy. The program features auto install, which creates an auto launch icon on the desktop. This icon can be e-mailed to the various workstations within the department, providing easy access for all users.

The DIRECTREES® program can be accessed from any computer, PDA or handheld device. This tool will be used by physicians, physics staff, therapists, and coders, ensuring accurate coding and maximizing revenue.

The DIRECTREES® license includes the following:

  • License per single address
  • Updates for one year
  • Newsletter subscription
  • A private account on our web page that includes 20 coding questions
  • Forms package


The SEQUOIA plan provides for annual licensing updates of the DIRECTREES® program. All features listed above are included with your annual license, which is paid yearly on your anniversary date.


The DIRECTREES® program is delivered via electronic download. The program is browser-based and can be loaded on standalone PCs or a central file server, providing easy access for all Licensed Users within the organization.

To display, the DIRECTREES® program requires:

  • A supported Internet browser (minimum versions: Internet Explorer (IE) 5.5, Netscape Navigator 6.0, Firefox 2.0)
  • JavaScript enabled display
  • Windows 2000, XP, or Vista operating system
  • 100 meg of free disk space

Simply click on the DIRECTREES® Help Icon on your desktop to launch the program. The TREES menu provides over ninety treatment regimen selections. Each sample TREE includes a case outline, comprehensive list of procedures in order of patient encounter, list of all associated codes, dynamic pop-up documentation guidelines to ensure that the user is aware of all coding and documentation requirements, and links to coding and reimbursement summaries.

The DIRECTREES® is a browser-based application that includes six main modules.
  1. TREES: The TREES menu provides over ninety treatment regimen selections. Each sample TREE includes a case outline, comprehensive list of procedures in order of patient encounter, list of all associated codes, dynamic pop-up documentation guidelines to ensure that the user is aware of all coding and documentation requirements, and links to coding and reimbursement summaries.
  2. Coding Summaries: This tab provides detailed coding summaries (all codes in order of patient encounter) and condensed coding summaries (codes in numeric order with total quantities). The detailed coding summary can be exported and attached to the patient account. Our unique format allows you to enter the date of service and final quantity. This process will ensure accurate coding and maximize your collections. The condensed coding summary is the ideal tool for final audit.
  3. Reimbursement & RVU: Reimbursement summaries are available for the majority of TREES. There are four reimbursement tables for each TREE. They include APC, technical, professional, and global reimbursement summaries. In addition, the corresponding RVUs have been calculated for every reimbursement summary. This module is the perfect tool for patient financial counseling, internal pro-forma work, and staff utilization.
  4. Rules of Thumb: This tab is our user's guide. As licensed users of the AMA, all CPT data is provided directly to you in this application. Information is supplemented with Medicare information, the Federal Register, and other pertinent sources. Documentation and utilization guidelines are included for every code. Additionally, a FAQ section provides the user with common questions with supporting answers to assist in implementing correct coding.
  5. Rates and RVU: This section provides tables demonstrating all current code reimbursement rates and associated RVUs.
  6. Newsletters: Churchill publishes the Churchill Update, a quarterly Newsletter. Newsletters provide information as rulings occur. Newsletters are added to the DIRECTREES® application twice a year. Our Newsletters are our way of keeping you current between releases.

The detailed coding summary can be exported to a word document and attached directly to the patient’s chart. Columns are available for you to simply add the date of service that the procedure was performed and the final quantity. Never miss codes again!

Reimbursement summaries are provided for APC, technical, professional, and global fee schedules. Synopsis graphs and data are also provided per region. Use this information for patient financial counseling, calculating your return on investment (ROI), projecting revenue, and calculating staff utilization.

The initial license to the DIRECTREES Coding Help Application includes a license and single release to the Radiation Oncology Dynamic Forms package at a reduced fee if purchased together.

Service F10 - SEQUOIA Annual Update Plan for DIRECTREES®

Fee: $2,500 Annual Fee from Initial Contract Date (Hospitals/Freestanding Centers, per licensed address)

Fee: $10,000 Annual Fee from Initial Contract Date (Billing Companies)

The SEQUOIA Maintenance Plan provides the maximum level of support, providing you with all upgrades of the new version modules as they are developed and released as well as all subsequent product updates for all user's listed on the initial licensing agreement for the period of one (1) year.

With this plan you will receive bi-annual version updates (first and third quarters) to the DIRECTREES® application, have electronic access to The Churchill Updates (quarterly Newsletters), and 20 coding questions in your private account on our web page.

Service F11: Comprehensive EMR Dynamic Forms Package

Initial Licensing Fee: $7,500 (per address)

Radiation Oncology Dynamic Forms created by Churchill Consulting, Inc., now know as Churchill Consulting, a division of CruxQS, offer providers with the perfect tool for EMR documentation. The Churchill 'forms package' is comprised of clinically appropriate forms with auto fill functions. Demographics, patient information, date of service (or other fields you select) will auto-populate when the form is appended to a patient's chart. Documentation is easy with dynamic dropdown selections and text fields, which allow you to type, dictate or use voice recognition software. Finish your procedures notes before the patient leaves the department!


Documentation is a mandatory part of coding. Churchill Consulting is a leader in the industry offering a unique comprehensive DYNAMIC forms package to assist organizations in documenting fully. Let Churchill provide you with a proven methodology for documentation that has successfully supported audits.

The Churchill dynamic forms integrate documentation requirements for carriers, such as Medicare, with clinical documentation required for accreditation. Combine that with Meaningful Use requirements for electronic medical records (EMR), and we offer you the perfect solution. Our dynamic forms will assist you in ensuring that the patient’s medical record can support the services provided with real-time documentation.

Our dynamic forms include auto-fill tags that will automatically enter data, such as patient name, demographics, diagnosis information, referring physician, etc., when appended to patient charts. Separate packages are available for ARIA and MOSAIQ platforms.

CLICK HERE to download a PDF file that includes a list of the Dynamic Forms included in first quarter CY2016 Dynamic Forms Version release.

Service F12: Annual Licensing Fee: Comprehensive EMR Dynamic Forms Package

Annual Licensing Fee: $1,000

Forms are released annually, usually in the second quarter. Subscribing to the annual licensing option will ensure that your forms remain current in regards to coding and documentation guidelines.

Please note: updates include standard platform base tags. Proven test tags for your center can be added for an additional fee of $500.


BASIC: $1,000

For those clients that already have a license to our forms, we charge a low rate of $1000 to add your logo, customize drop downs to reflect your equipment, add staff names, and add dose constraints following the completion of a worksheet by the physicians.

TAILORED: $3,500

We are available to customize many of the forms included in our Dynamic Forms package via Webcast based workshop with your physicians.

This service includes up to 5 hours of Webcast and 12 hours of in-office customization.

Step 1: The interview process begins with the presentation of the clinical treatment planning note and special treatment procedure note to determine if the physicians would like to combine the two notes into one robust form.

Step 2: Multiple styles of progress notes are available and will be presented for consideration. During the interview, the physicians will define the elements and flow of the weekly progress note.

Step 3: Each region specific form set included in the customization are as follows: clinical treatment planning note, simulation order, dosimetry order, imaging order and pre-planning simulation note. Each region also has an informed consent, which will be included in the packet but must be customized by the physicians.

During the scheduled webcast, one set of forms for one region, i.e., breast or prostate, will be presented to the physicians for interview. We ask that the physician(s) make decisions on format, the order of information, adding a component, removing or moving a section, etc.

We then make those same changes in the other region specific forms and submit the forms for direct edit by your physicians and staff.

Additional Customization:

Although there are a myriad of other forms, the 'tailored' service is limited to customizing the forms listed above. You may schedule additional time to interview other forms of your choice.

  • Additional Webcast interview: $300 per hour, and includes a toll free dial in number
  • Additional form customization: $187.50 per hour

TURNKEY: $12,500

The turnkey service includes 20 hours of customization, 6 hours of webcast interview and 16 hours on-site. The services listed in the tailored service are included, with an additional 2 hours of Webcast interview and 10 additional hours of in-office customization.

The on-site time includes up to 10 hours for the import of the selected forms and 6 hours of staff training.

Service Description Cost Forms+Basic+Tailored
Dynamic Forms License $7,500 License per Address
Basic $1,000
  • Logo
  • Staff names
  • Dose constraints added to orders
Tailored $3,500
  • 5 hours webcast interview
  • 12 hours in-office customization
Total $12,000 Additional hours may be contracted

Service Description Cost Forms+Turnkey
Dynamic Forms License $7,500 License per Address
Turnkey $12,500
  • Logo
  • Staff names
  • Dose constraints added to orders
  • 20 hours of customization
  • 6 hours webcast interview
  • 16 hours on-site
  • Total $20,000
  • Plus Travel
  • Additional hours may be contracted

  • Form packages include generalized forms and region specific packages. When a patient begins treatment, simply append the packet of forms that are required for the course. Many of the forms listed in the general forms list above are customized per region. The following table lists the regions that customized forms are available for. We have spent hundreds of hours creating clinically pertinent forms that clearly describe the procedure as it was performed. These notes are not 'cloned' notes that simply state a procedure was performed; these forms provide a concise summary of the procedure for each patient, completely customized by the individuals performing the procedure. All forms have dynamic drop-down selections that allow the user to quickly and accurately document the work as it is performed.

    Region Specific Forms
    Head and Neck
    Male Pelvis
    Female Pelvis

    Service F13: DIRECTREES® Coding Help Application and Comprehensive EMR Dynamic Forms

    Fee: $15,000

    Purchase the DIRECTREES® Coding Help Application and Comprehensive EMR Dynamic Forms together to ensure appropriate coding and supporting documentation. If purchased separately, the price would be $20,000.

    This service will provide you with:

    • Initial DIRECTREES® license
    • Initial Forms license
    • Unlimited coding support via private account
    • Updates for both products for a one year
    • Discount of 20% on any other product or service for license year


    Service F14: On-Site Day Rate

    Fee: $3,500 – Initial day on-site.

    Fee: $2,500 per day for each additional day on-site.

    The day rate applies for services that are performed on-site and do not require preparation prior to the visit or result in a work product.

    Service F16: Practice Pro-Forma Report

    Fee: $2,500 - $5,000

    Practice Pro-forma

    Our standard practice pro-forma provides the calculated reimbursement for up to twenty (20) sample regimens and gross projected revenue for up to seven fee schedules (five in addition to Medicare and commercial).

    Step 1: Establishing Regional Disease Distribution

    The client shall provide the disease distribution for the geographic area to be examined. Current cancer statistics list the following for as the most commonly diagnosed cancers in the United States: Breast cancer, Cervical cancer, Colorectal (colon) cancer, HPV-associated cancers, Lung cancer, Ovarian cancer, Prostate cancer, Skin cancer, and Uterine cancer.

    Once the diagnoses have been established, the percentage per site must be established (also provided by client).

    Step 2: Defining Treatment Regimens

    There may be multiple treatment options for one diagnosis. For example, prostate patients may be treated with IMRT, a seed implant, or IMRT followed by a seed implant. The physician will be asked to complete a regimen summary worksheet, which includes the modality, fractionation, portal arrangement, immobilization, etc., for each of the treatment techniques that might be considered.

    Based on this information, the reimbursement for up to twenty regimens is calculated for the adjusted Medicare fee schedule, representing your geographic adjustment.

    Step 3: Commercial Rate

    The client will be asked to provide a commercial fee schedule. The gross billing will then be calculated using the distribution and treatment regimens already calculated.

    Step 4: Carrier Rates

    Client may include up to five (5) carrier fee schedules, expressed as a percentage of Medicare or Commercial. For example, carrier 1 might pay 80% of the commercial fee schedule; carrier 2 might pay 120% of the Medicare rate.

    Step 5: Carrier Mix

    An average mix might be 65% Medicare, 3% no-pay, 10% commercial, 5% Blues, etc.

    Step 6: Calculated Projected Gross Revenue based on Carrier Mix

    Client shall define the percentage of patients per regimen. For example; 25% of patients are breast. Within that 25%, 75% are planned with 3D and 25% are planned with IMRT.

    Final Report

    The total projected 'gross' revenue will then be calculated, based on the percentage per diagnosis, per carrier mix.

    Base Fee: $2,500

    Additional regimen summaries are charged, per contract rate.

    Additional fees apply for multiple fee schedules,i.e., hospital and professional.

    Additional reporting, other than the standard findings, is charged in addition to the pro-forma service.

    Service F17: Customized Pro-Formas

    Fee: Variable

    Churchill Consulting is available to provide any customized pro-forma that you require. Prices vary based on requirements.

    Service F18: Newsletter

    Fee: $250 per year

    Click here for details on subscribing to The Churchill Consulting's Newsletter.

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