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Pain Point Series: Is Down-Coding Bringing Your Revenue Down?

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Thanks to all of you who have been following along with our Pain Point Series. We’ve really enjoyed hearing your stories and feedback. Today we continue the series with Pain Point #5, Down-Coding. Do you ever get the feeling all of your charges are not being captured? How would you find out for sure? What can you do to fix it? We’ve teamed up with our Coding Compliance Auditor, Micah Swihart, to help answer some of your questions.

Down-coding occurs anytime a facility is unable to capture the maximum amount of applicable codes and modifiers and/or code charges to the highest level of specificity for a given procedure(s). This often occurs due to insufficient documentation or detail in the operative note. For example, a failure to notate a diagnosis, the specific location of an additional debridement or treatment, or the laterality of a procedure will each result in down-coding and loss of revenue. Furthermore, a pattern of down-coding causes a lack of faith in the billing department on the part of the physician(s).

Of course, we’d never leave you high and dry. Here are some steps you can take in your Ambulatory Surgery Center in order to reduce down-coding.

Meet regularly with your physicians. Have your coder(s) save examples of scenarios where they think additional detail would be helpful and potentially result in additional/higher value codes. Share these examples with your physicians regularly so that together, you can all help maximize reimbursements and (hopefully) disbursements!

Audit often. You don’t always have to be the bad guy or gal. Have your coding audited (at least) annually. A good auditor will point out documentation that is a bit vague, or getting very close to an additional code/modifier/RVU so this can be reviewed internally.

Make way for continued education. Attending conferences can be a fun and informative way for physicians to stay up to date with changing coding and documentation requirements. It’s helpful to budget time and money for physicians to attend at least one conference per year geared towards their specialty. Pick some place nice! It always helps get buy-in.

If you’re ready to schedule a coding audit or are ready to relieve your center of the coding burden once and for all, give us a call! We’ve been coding and billing specifically for ASCs for over a decade now. Our expertise has helped countless centers improve their charge capture and reimbursement. We’d love to learn more about you and your team!

Leave us a comment below or give us a call today at 855-208-5566!

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