1. Host additional training. The fast pace of an ASC setting can hurt coding accuracy, said Lolita M. Jones, RHIA, CSS, is an independent coding and billing consultant. Centers may need to do periodic one-hour clinical overview sessions with physicians and coders. At the review sessions, physicians can go over techniques, medical necessity and documentation so the coders can understand what goes into certain operations and thus how to properly code them.
"You can go online and do research, but if a physician explains it to you, that's an extra layer of education that an ASC can sometimes prohibit from happening," she said.
2. Avoid unlisted codes. If a physician dictates a procedure in an operative note that does not fall under a current procedural technology code, then a coder may have to resort to using an unlisted code. Since Medicare does not reimburse for unlisted codes, these codes cost centers profits.
"You could be leaving money on the table," said Brenda Myers, associate senior vice president of business office operations for ASD Management.
While unlisted codes cannot be completely avoided, centers can take steps to make sure they are not unnecessarily used. For instance, Ms. Myers said, a solution could be educating a physician on a similar technique which does have an assigned code or helping the physician use proper supporting documentation in an operative report to qualify for a code.
3. Set and meet accuracy standards. The only way to know if your coders are staying accurate and timely is by setting an accuracy target and doing periodic audits to measure the accuracy rate.
Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions, suggests coders be asked to maintain at least a 95 percent accuracy rate and said up to 98 percent is reasonable and attainable.
Whenever a new coder joins your center, he or she should be audited more frequently until all parties are confident in the coder's abilities to perform at an expected level.
Accuracy may also be taking a hit if coders are simply entering what the physician has checked off on the charge ticket, rather than actually coding the claim. Coders cannot rely on the ticket, Ms. Jones said. They can validate against the physician notes, but they should be coding as well.
4. Monitor clearing house claims. Most surgery centers bill electronically for faster turnaround, but it is still important for billers to continuously monitor clearing house claims, Ms. Myers said.
Monitoring the electronic claims allows billers to discover problems before the current claims age and fix them for quicker turnaround. "If there is a glitch in a case at the clearing house level or payor level, you can catch it then, too," she said.
By monitoring these claims, billers can also read the error reports to learn which claims cause problems and how to avoid those problems in the future.
5. Bill patients immediately after surgery. Third party services can help ASCs obtain debit or credit card information so payments can be automatically deducted. ASCs should aggressively monitor the payment plan. It's important to call and speak to the patient if payment is delinquent. "Passive aggressive behavior is not going to get you your money back," said Catherine Meredith, vice president of finance for the Ambulatory Surgery Centers of America.
Even though ASCs want — and need — to be reimbursed, it's also important to empathize with patients struggling to make payments given this is still a difficult economic time for some. Ms. Meredith said ASCs should work with patients to come up with a payment solution fair for both parties.
6. Include quality codes. Changes have taken place for compliance with Medicare quality codes, known as G-codes, and coders will need to appropriately using them.
Currently, billers are responsible for including G-codes for claims with Medicare as the secondary payor in addition to the primary payor. Often clinical personnel will enter G-codes into the billing system for all patients, but billers must work to ensure only Medicare claims are submitted with quality reporting, said George Kaplinksi is the vice president of operations for ASC billing services at SourceMedical.
"We think if you start putting these G-codes on non-Medicare claims, you will have issues with other payers, as they will not recognize them as legitimate codes," he said.
Fifty percent compliance was required in 2012 or Medicare will reduce an ASC’s payments by 2 percent in 2014, Mr. Kaplinksi said. It's crucial to submit claims with applicable quality codes the first time because Medicare will not allow resubmissions for missing G-codes.
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"You can go online and do research, but if a physician explains it to you, that's an extra layer of education that an ASC can sometimes prohibit from happening," she said.
2. Avoid unlisted codes. If a physician dictates a procedure in an operative note that does not fall under a current procedural technology code, then a coder may have to resort to using an unlisted code. Since Medicare does not reimburse for unlisted codes, these codes cost centers profits.
"You could be leaving money on the table," said Brenda Myers, associate senior vice president of business office operations for ASD Management.
While unlisted codes cannot be completely avoided, centers can take steps to make sure they are not unnecessarily used. For instance, Ms. Myers said, a solution could be educating a physician on a similar technique which does have an assigned code or helping the physician use proper supporting documentation in an operative report to qualify for a code.
3. Set and meet accuracy standards. The only way to know if your coders are staying accurate and timely is by setting an accuracy target and doing periodic audits to measure the accuracy rate.
Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions, suggests coders be asked to maintain at least a 95 percent accuracy rate and said up to 98 percent is reasonable and attainable.
Whenever a new coder joins your center, he or she should be audited more frequently until all parties are confident in the coder's abilities to perform at an expected level.
Accuracy may also be taking a hit if coders are simply entering what the physician has checked off on the charge ticket, rather than actually coding the claim. Coders cannot rely on the ticket, Ms. Jones said. They can validate against the physician notes, but they should be coding as well.
4. Monitor clearing house claims. Most surgery centers bill electronically for faster turnaround, but it is still important for billers to continuously monitor clearing house claims, Ms. Myers said.
Monitoring the electronic claims allows billers to discover problems before the current claims age and fix them for quicker turnaround. "If there is a glitch in a case at the clearing house level or payor level, you can catch it then, too," she said.
By monitoring these claims, billers can also read the error reports to learn which claims cause problems and how to avoid those problems in the future.
5. Bill patients immediately after surgery. Third party services can help ASCs obtain debit or credit card information so payments can be automatically deducted. ASCs should aggressively monitor the payment plan. It's important to call and speak to the patient if payment is delinquent. "Passive aggressive behavior is not going to get you your money back," said Catherine Meredith, vice president of finance for the Ambulatory Surgery Centers of America.
Even though ASCs want — and need — to be reimbursed, it's also important to empathize with patients struggling to make payments given this is still a difficult economic time for some. Ms. Meredith said ASCs should work with patients to come up with a payment solution fair for both parties.
6. Include quality codes. Changes have taken place for compliance with Medicare quality codes, known as G-codes, and coders will need to appropriately using them.
Currently, billers are responsible for including G-codes for claims with Medicare as the secondary payor in addition to the primary payor. Often clinical personnel will enter G-codes into the billing system for all patients, but billers must work to ensure only Medicare claims are submitted with quality reporting, said George Kaplinksi is the vice president of operations for ASC billing services at SourceMedical.
"We think if you start putting these G-codes on non-Medicare claims, you will have issues with other payers, as they will not recognize them as legitimate codes," he said.
Fifty percent compliance was required in 2012 or Medicare will reduce an ASC’s payments by 2 percent in 2014, Mr. Kaplinksi said. It's crucial to submit claims with applicable quality codes the first time because Medicare will not allow resubmissions for missing G-codes.
More Articles on Coding, Billing and Collections:
Florida Senate Bill Could Change County Medicaid Pay Formula
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8 Legislative & Regulatory Changes Impacting Ambulatory Surgery Centers