Maximizing Reimbursement
and Staving Off Penalties through Oversight
Outpatient Surgery Magazine, July 2017. Your ASC is not only accountable for its
actions but also the actions of its business partners providing services on behalf
of your ASC. In the case of outsourcing, quite frequently an ASC develops an unhealthy
– out of sight out of mind – complacency. It is necessary to establish internal
controls with consistent monitoring of all aspects of the revenue cycle whether
performed in-house or handled offsite by an independent central business office
or billing company. Most ASCs understand that monitoring of its revenue cycle is
essential but unfortunately, some fall short in execution. Consistent weekly/monthly
internal audits of all aspects of the revenue cycle from A to Z should be conducted.
10 Best Practices for Establishing
Internal Coding Audits
Becker's ASC Review, July 28, 2010. An existent compliance plan not only detects
incorrect coding
practices, it may also be considered by some federal agencies when determining whether
reasonable efforts were taken to avoid and detect fraud and abuse. Let's look at
the following 10 best practices for establishing internal coding audits at your
ASC.
8 Key Points to
Consider (and a Checklist to Use) When Selecting
an External Coding Audit Company
Becker's ASC Review, July 27, 2010. ASCs should incorporate an external audit into
their compliance programs. Formal coding audit protocol should define the purpose
of the audit, frequency of review and sample size. The difficult part is selecting
a credible auditing company. The interview process can be tedious, but remember,
your final selection will impact your facility's bottom line. Consider the following
key points when conducting your search.
Physician Queries Done Right
Outpatient Surgery Magazine, May 2010. How to ask a
physician to clarify inconsistent or vague documentation. While most surgeons document
the surgical procedures they perform in your facility with the utmost precision,
there may be times when your coder needs clarification or additional documentation
before she can assign the proper codes. When there's conflicting, incomplete or
ambiguous information in the operative report, you must ask the physician to verify
the procedure performed and to get any written clarification in the form of an addendum.
The official name for this is a "physician query." What it really means is, "Doc,
we need you to clarify exactly what you did."
How to Report Post-op Pain Blocks
Outpatient Surgery Magazine, October,
2009. Deciphering different post-op pain directives is key to getting the proper
reimbursement. When it comes to getting paid for post-op pain blocks, not all payors
require the same documentation and proof of medical necessity. Some commercial carriers
follow the Medicare edits and guidelines while others don't follow Medicare reimbursement
– potentially allowing for more aggressive coding and reporting. Here's a review
of different post-op pain directives.
5 Best Practices
for Improved Coding of Orthopedic and Spinal Procedures
Becker's ASC Review, April 28, 2009. The reporting of orthopedic, spinal and pain
management procedures continue to provide challenges for many ASCs regardless of
whether the coder is a novice or a seasoned veteran. Below are five best practices
to help ensure your facility captures reimbursement opportunities while adhering
to coding guidelines.