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Common billing and coding mistakes ambulatory surgical centers make

26 Jan 2018, Posted by Jocelyn Gaddie in ASC Billing & Coding

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Consistent cash flow is necessary to keep your ambulatory surgical center operating smoothly, but sometimes coding errors can lead to billing mistakes, delays in processing, and a disruption in that all-too-important cash flow cycle. The good news is that most of these errors can be avoided. Here are some of the most common mistakes made in ambulatory surgical center billing and coding.

 

Operational Errors

Some of the easiest errors to correct are those that are fundamentally operational. For example:

  • Insufficient staffing: If you’re trying to manage all of your billing, coding, and collections with a small staff to help reduce your overhead, that’s where mistakes are often made. If you’re not in a position to hire more administrative staff, you should consider outsourcing some of your billing and coding work to a qualified ASC billing company. It will save you time and money, reduce errors, and help to improve your cash flow.
  • Unclear reporting: If there are multiple procedures or elements that are included in a single surgery and you don’t specifically detail all of them, your coding staff may miss the chance at billing some of them. That’s lost revenue. Don’t assume that your staff will automatically know that added steps or that certain procedures are included. Be attentive to detail when completing your dictation to ensure accuracy in the coding process.
  • Not tracking denials: Even if your staff is on top of processing denials, fixing the problems, and getting them paid, if you don’t track the denial trends, you’re potentially slowing your cash flow unnecessarily. You should have a system in place where all of the denials are entered, including who denied the bill, the reason for the denial, who did the initial coding, and what the final result was. That way, you can review the aggregate data to find trends. Whether you’re seeing denials from many payors due to errors in the procedure coding or you have one payor who is denying the majority of the bills the first time through, you’ll be able to spot the problem and address it.

 Reporting Errors

Sometimes your biggest coding errors come from the reporting process itself. Here are some things you should be attentive to in your reporting:

  • Using outdated forms: If you haven’t updated your patient encounter forms in some time, you’re likely to be missing out on some key revenue opportunities. There are constant changes to the coding system and the DSM, and using outdated forms means that you may not have some of the latest codes available to you. Even forms as little as a year old can be outdated, so prioritize this for increased revenue opportunities.
  • Unclear procedure reporting: When your procedure report heading mentions an open procedure but the report details mention an arthroscopic approach, it can leave your coding staff confused and lead to mistakes in billing. Since open procedures bill at a higher rate, it’s important that you’re clear about what type of procedure was done. If a procedure starts out as an arthroscopic one and you find that you have to migrate to an open surgery, make sure this is clearly defined in the report so that your coders know to bill for open surgery, not arthroscopic.
  • Missed or misused modifiers: One of the most common reasons for a billing denial is a mistake made in the use of the modifiers. Whether it’s due to unclear reports from your patient encounter or oversight on the part of your coders, these errors can cost you significantly. Make sure that your documentation is clear for your coders so that they know when there’s need for a modifier in the coding. For example, if you’re providing multiple distinct services (such as counseling and surgery) to a patient in the same surgical procedure appointment, you should clearly define this so that your coders can make use of modifier 25 to flag it as such. In addition, code 59 should always be used when you perform multiple procedures (such as nerve repair in the foot and surgical repair of a toenail problem) in one surgical session if those procedures wouldn’t otherwise be clearly distinct in the reporting.
  • Not using separate codes for multiple techniques used: If you’re removing multiple cysts and you remove two of them using one technique for biopsy preservation and the rest using another technique because preservation is unnecessary, those two separate techniques should be clearly coded as such. Make sure that it’s clear in your reporting so that your coders know that there was a difference.

If you are looking for a partner for the financial aspect of your business, reach out to our team. We help physicians, office managers and administrators improve financials for strong performance. Contact us to set up a meeting today!

 

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