Here are seven tips from ambulatory surgery center revenue cycle management experts on ways to improve coding and billing cycles.
Obtain full documentation for spine procedures, operative notes, anesthesia and medication lists before you begin coding.
“You have to make sure all is in order before starting to code,” said Angela Talton, National Medical Billing Service’s senior vice president, coding. “There are several challenges, especially when we have more than one procedure. We have to ensure we are assigning the level of specificity for any spine procedure and the correct modifiers. Claims can be denied because modifiers are not affixed to the second tertiary procedure. That can be very costly and time consuming from a revenue cycle point of view.”
This documentation will become even more specific after the transition to ICD-10 in October 2014. Surgery centers can provide physician education courses to make sure they are ready for the transition.
“Physician education is going to be critical during the upcoming days, weeks and months leading up to ICD-10 conversion,” Ms. Talton said. “Physicians need to be made very aware of how they are noting procedures. They need to be very specific and aware of how they are wording their reports to avoid ambiguity in their operative findings. Otherwise, there is a huge drop in reimbursement because of that.”
“Statistics show that medical practices never collect on 18 percent of their claims due to their lack of resubmitting claims that were denied on the first pass,” said President and CEO of RMK Holdings and Co-Founder of Medical Bill & Claim Resolution Sunni Patterson. “In addition, it is estimated that providers are underpaid by an average of between 7 percent and 11 percent on claims that they do submit, mainly due to medical coding errors.”
Billing professionals should strive to collect this lost revenue through improving, upgrading and automating the practice’s revenue cycle management system. New technologies, such as EHRs and practice management systems, can be used to do this.
“One of the most effective actions to take and one that speaks directly to the statistics related above is to implement a potent rules engine, one that will not only check for the proper coding but automatically identify the claims most likely to be denied,” he said.
Experience and expertise are crucial, said Andy Salmen, director of business development at Healthcare Information Services. ASCs can improve billing and revenue by hiring or partnering with experts in the field.
“To have an efficient and effective management of the practice’s reimbursement, it is imperative that experienced professionals are an integral part of the revenue cycle,” he said. “Look for professionals or organizations that have a proven track record within your specific specialty [such as] orthopedics or ASC.”
Coders are the last line of defense before a claim is submitted for payment, and these staff members have to be able to deal with challenges such as incomplete physician documentation, multiple procedures, compliance issues, modifiers and unclear operative notes, said April Sackos, CASC, is the vice president of revenue cycle management at ASCOA.
The best people to handle such challenges are certified coders with surgery center experience who have access to current information about coding and regulatory changes. Well-trained coders will submit accurate claims and get their surgery centers paid promptly.
“Coders should have their work audited at least annually and have a 95 percent accuracy or better,” she said. ASC managers should implement continuing education based on the needs of the coders and the results of audits.
Quality measures will continue to be ramped up for ASCs, so coders and billers should seek additional coding certification to handle the new procedures and regulations, both for healthcare generally and for their specialty.
“It is common to see coders now with two or more certifications, and I believe that will increase,” said Billing and Collections Manager Tammy Luttenberger of Hudson Valley Ambulatory Surgical Center in Middletown, N.Y. “It’s important to maintain current credentials and consider adding more to verify our expertise.”
Caryl Serbin, RN, president and founder of Serbin Surgery Center Billing and Surgery Consultants of America said it is not uncommon to find surgery centers working from outdated CPT and ICD reference books.
“They don’t always recognize this as an important investment,” she said. “But keeping up with frequently changing regulations and requirements is a priority. The Office of the Inspector General has made it abundantly clear that they will monitor and enforce changes. Purchasing annual CPT and other coding materials is a small price to pay for compliance.”
Modifiers are usually two-digit numbers or letters added to CPT codes (procedures) to identify variations or specificities affecting the procedure. They might indicate a number of things such as complications, interrupted surgery or which toe or finger.
“Many coders do not realize the importance of using modifiers,” said Judith English, vice president of business of Serbin Surgery Center Billing and Surgery Consultants of America. “This can negatively affect your reimbursement and possibly cause an unnecessary denial.”
Ref. Becker’s Healthcare
This post was first published March 7, 2013 and was updated July 29, 2020.