Accurate and efficient billing and coding are vital to an ambulatory surgery center’s financial health. Coding errors, processing delays, and denied claims can interfere with your ASC’s cash flow and have a negative effect on your overall Revenue Cycle Management.
But many common billing and coding mistakes can be avoided easily. Here are five important things you need to know to steer clear of costly and time-consuming mistakes.
You must put codes in the correct order.
For multiple procedures or diagnoses, it is essential to record all of the correct codes and sequence them properly. The order codes are listed in make a difference when it comes to reimbursement. Start with the primary or most serious diagnosis, which is generally determined as the main reason for the patient’s visit or the condition with the highest risk. Recording codes from highest to lowest reimbursement will maximize the amounts you receive from payers.
Clear reporting is necessary for accurate coding.
Make sure that all procedures, techniques, and other important details are specified for coders. If a patient underwent multiple procedures, outline each one clearly in your reporting. Don’t make coders guess about any elements in a patient’s case, as this can lead to incomplete billing and lost revenue.
A small billing and coding staff can actually lose you money.
To save money, ASCs may try to keep administrative staff to a minimum. But when it comes to billing and coding, this strategy can backfire. A small, overstretched staff has trouble keeping up with the volume of paperwork – and it is more susceptible to errors and oversights. For this reason, many ASCs decide to outsource their billing and coding work to a company that specializes in Revenue Cycle Management. A dedicated outsourced team handling all of the billing and coding can actually save your center time, money, and stress.
Incorrect modifiers are expensive.
Some CPT and HCPCS codes require modifiers that provide more information about the procedure performed. Incorrect or missing modifiers are a common cause of billing denials, delays, or payment reductions. Research the most frequently used modifiers and provide clear documentation for coders when modifiers are necessary.
You need to track denial trends to fix problems.
Set up a system to track and analyze denials your ASC receives. Record who denied the bill, the reason for the denial, who was the coder, and what additional steps were taken to resolve the issue. Over time, you will be able to see trends and find solutions for problem areas.