Ambulatory Surgery Centers (ASCs) or outpatient surgery centers that provide same-day surgical care, including diagnostic and preventive procedures face diverse problems, mainly related to physician reimbursement. Accurate pain management billing and coding for spine surgery procedures can pose challenges for many ASCs. Becker’s 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference held in Chicago from June 22 to 24, 2017 discussed the various obstacles that ASCs face related to proper coding and billing.
Becker’s Hospital Review noted that in 2014, despite the changes in the industry and across healthcare, there were approximately 5,500 ambulatory surgery centers across the country. Staying viable in the healthcare industry can be challenging for surgery centers as the market consolidates and reimbursement falls.
In order to stay competitive and profitable, ASCs need to overcome in-house billing challenges and comply with the legal framework changes. Becker’s ASC Conference also shared a few strategies to ensure successful reimbursement. These strategies include:
- Choosing efficient medical coding specialists – The coders’ experience in documenting spinal procedures matters a lot. They must be able to match the spinal nerves involved in a particular surgery to the proper code and assign an accurate number of levels. With advancements in surgical technology, ASCs are continually adding new instruments and medical products to their surgical collection. The coding staff should also thoroughly research appropriate coding practices for each new medical device to ensure claim approval.
- Physician documentation in operative notes should be detailed and accurate – Inaccurate or incomplete documentation is a major reason for claim denials. Lack of relevant details also confuses the coder, resulting in coding errors. So physicians, in their operative notes, must clearly include the aim of the procedure and how it is performed.
- Stay up-to-date with changes in medical policy – Billing policies vary with the choice of carriers. The methodology and efficiency of reimbursement for pain management procedures has drastically changed over the past few years. Follow the routine documentation procedures that have been effective in the past, but now result in denials. Your medical coding team must be aware of the differences and updates to each policy’s requirements. The team must also keep track of the coding changes and updates such as which codes have been deleted or replaced, as payers will reject the claim if you use an outdated code.
- Consider patient responsibility – It has been recommended to implement an internal collections policy, as patient responsibility will soon be a concern. According to the Healthcare Financial Management Association, patients will be responsible for 40 percent of a healthcare provider’s bill by 2020.
- Utilize advancements in technology – The meeting recommends ASCs to switch to high-tech medical billing practices, such as using automated registration tools, patient portals to eliminate calls and more. These solutions will help reduce staff expenses and increase cash collections.
Insurance verification services also play a key role in ASC revenue cycle management. Verifying patients’ coverage before the treatment helps to understand the type of plan that the patient has and the carrier responsible for payment. Also consider whether prior authorization is required, as for certain procedures the claim will not be paid without authorization.
Common billing mistakes that slow down the claim processing in ASCs include failure to address local coverage determinations (LCDs), failure to timely appeal incorrect payments, failure to monitor and benchmark key performance metrics, and avoiding payment posting. Busy ASCs can consider medical billing and coding outsourcing, as it can help improve the center’s operations and revenue. Choose a professional, experienced billing company that can effectively manage your revenue cycle, ranging from scheduling to payment.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.