Three experts on revenue cycle and operations at ASCs gathered at the Becker's ASC 25th Annual Meeting: The Business and Operations of ASCs conference in Chicago Oct. 19 to discuss how administrators can improve reimbursement per case at their facilities.
Here are three pieces of advice they shared on how to avoid claims denials:
1. Be proactive, says Angela Mattioda, vice president of revenue cycle management services at Surgical Notes: "Know your center and anticipate what kind of denials [you'll see]," Ms. Mattioda said. "A lot of denials have to do with [local coverage determinations] or medical necessities, so know the pain cases and the orthopedic cases that are causing these types of denials — If you need to have letters of medical necessity on hand, have those so you can handle that denial, prove the justification and get that appeal out the door."
2. Ensure the team is on the same page, says Melanie Pucella, vice president of operations at AOK Medical Center in Houston: "It's all about the details and making sure you're putting the information in correctly," Ms. Pucella said. "[To justify medical necessity,] it's about educating the provider on how to do his or her notes correctly. I've gone so far as to make a cartoon PowerPoint about the charting process … We also have a certified coder with our outsource billing company who reviews everything. We're very selective with our vendors that we use."
3. Address denied claims immediately, says Michael Graziano, administrator at Clifton (N.J.) Surgery Center: "At our center, the most important thing that we can do is to handle denial of claims immediately. If you get them, you have to handle them right then and there, otherwise you're risking that you might forget them and miss the deadline," Mr. Graziano said. "We need to stay on their timeline, so we don't ever give them that reason to [deny a claim]."