Here are five coding and billing problems from industry experts to avoid in ambulatory surgery centers.
1. Poor contracting. Try to get better contracts, review all of them and see who is out of line and what you can do about it, said Taylor Moorehead, regional partner for Zotec Partners and corporate compliance officer. He suggests that unbundling all of CMS' bundling for services by carrier can be lucrative.
2. Mismatched fee/service invoices. Since the teams of coders responsible for generating codes for professional and facility fees rarely work together or perform internal reconciliation, it is easy for incomplete documentation to be interpreted and coded incorrectly, said Sean Benson, co-founder and vice president of consulting, ProVation Medical.
"In fact, the OIG estimates that 23 percent of all claims do not match between the facility and the professional components," he said. These mismatched bills are typically returned by the payor and require costly reprocessing before they can be resubmitted. That is the best-case scenario. Worst case is a permanent loss of revenue and even fines by the OIG, which is now checking for billing discrepancies and has already levied record-breaking fines for construed overbilling."
3. Allowing late patient pay. Avoid the problem of late patient pay by getting all of the patient's portion up front, Mr. Moorehead said. "If they can't pay, use a service to charge their credit card every month or checking account," he said.
4. Not filing claims on time. Failing to meet timely filing requirements can cost ASCs money, said Caryl Serbin, RN, president of Surgery Consultants of America.
"Depending on your contracts, the payor could demand that you bill within 15 or 30 days," she says. "When negotiating, we aim for a one-year timely filing deadline like Medicare, but if you accept a boilerplate contract from a payor and don't read the fine print — timely filing language could come back to haunt you.".
She said sometimes receiving the operative notes could take several days to weeks, and by then you may have already missed your deadline. "Then you might not get paid at all, something that happens more often than you'd think when the facility doesn't have sufficient staff members dedicated to coding, billing and collections," she said.
5. Inaccurate dictation can lead to underbilling or overbilling. Coders rely on accurate dictation of procedures from surgeons so they can bill appropriately for them. Many times coders will bill correctly for the main procedures but miss add-ons if the report is not clear.
"Dictation and transcription are often done quickly so they can get to billing," said Brice Voithofer, vice president of anesthesia and ASC services for AdvantEdge Healthcare Solutions. "However, ASCs can take these missed add-ons as opportunities to educate staff members and find more revenue."
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1. Poor contracting. Try to get better contracts, review all of them and see who is out of line and what you can do about it, said Taylor Moorehead, regional partner for Zotec Partners and corporate compliance officer. He suggests that unbundling all of CMS' bundling for services by carrier can be lucrative. 2. Mismatched fee/service invoices. Since the teams of coders responsible for generating codes for professional and facility fees rarely work together or perform internal reconciliation, it is easy for incomplete documentation to be interpreted and coded incorrectly, said Sean Benson, co-founder and vice president of consulting, ProVation Medical.
"In fact, the OIG estimates that 23 percent of all claims do not match between the facility and the professional components," he said. These mismatched bills are typically returned by the payor and require costly reprocessing before they can be resubmitted. That is the best-case scenario. Worst case is a permanent loss of revenue and even fines by the OIG, which is now checking for billing discrepancies and has already levied record-breaking fines for construed overbilling."
3. Allowing late patient pay. Avoid the problem of late patient pay by getting all of the patient's portion up front, Mr. Moorehead said. "If they can't pay, use a service to charge their credit card every month or checking account," he said.
4. Not filing claims on time. Failing to meet timely filing requirements can cost ASCs money, said Caryl Serbin, RN, president of Surgery Consultants of America.
"Depending on your contracts, the payor could demand that you bill within 15 or 30 days," she says. "When negotiating, we aim for a one-year timely filing deadline like Medicare, but if you accept a boilerplate contract from a payor and don't read the fine print — timely filing language could come back to haunt you.".
She said sometimes receiving the operative notes could take several days to weeks, and by then you may have already missed your deadline. "Then you might not get paid at all, something that happens more often than you'd think when the facility doesn't have sufficient staff members dedicated to coding, billing and collections," she said.
5. Inaccurate dictation can lead to underbilling or overbilling. Coders rely on accurate dictation of procedures from surgeons so they can bill appropriately for them. Many times coders will bill correctly for the main procedures but miss add-ons if the report is not clear.
"Dictation and transcription are often done quickly so they can get to billing," said Brice Voithofer, vice president of anesthesia and ASC services for AdvantEdge Healthcare Solutions. "However, ASCs can take these missed add-ons as opportunities to educate staff members and find more revenue."
More Articles on Coding, Billing and Collections:
Survey: Rate of Physician Participation in ACOs Triples
Texas Representative Looks to Stop ICD-10 Implementation
Survey: Billing Impacts Patients' Opinion of Overall Quality of Care