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100 ASC & physician practice coding, billing & revenue cycle tips

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Financial management is essential to overall ambulatory surgery center and physician practice health. Here are 100 tips from various industry experts on billing, coding, collections, electronic health records, ICD-10, new payment models and revenue cycle management.

Billing

6 tips for selecting a billing services company

•    Inquire about staff.
•    Look for coders who have ASC experience.
•    Set realistic expectations.
•    Take a team approach.
•    Request monthly reports.
•    Don't forget to benchmark.

2 tips to improve ASC billing

•    Optimize scheduling strategies to eliminate as many cancellations as possible.
•    Analyze data and look for trends to build strategies for improvement.

Reduce billing costs: 4 areas to focus on

•    Staffing. Overstaffing leads to unnecessary expense and understaffing can lead to slow claims processing. Find the right balance.
•    Technology. Understand the value of maintaining technology. Upgrades and customization after the initial investment in billing technology can help keep the billing process running smoothly.
•    Integration. Finding a cost-effective clearinghouse can lead to faster claim submission and responses.
•    Automation. Automatic claims processing ensures the maximum amount of claims is being collected.
 
7 tips for effectively managing ASC billing processes

•    Don't overlook scheduling.
•    Conduct insurance verification ahead of time.
•    Leverage an EHR.
•    Know your contracts.
•    Monitor claims submission.
•    Stay on top of unbilled patient accounts.
•    Measure and manage information.

Additional billing resources

4 of the most common ASC billing questions answered

Mapping out a game plan for efficient in-house billing

Coding

5 coding tips for spine surgery at ASCs

•    Obtain correct physician documentation.
•    Code for add-ons when possible, but don't unbundle.
•    Employ modifiers appropriately.
•    Understand the coded anatomy.
•    Continue coder education as procedures evolve.

Avoid surgery center claim denials: 5 expert tips

•    Look for unbundled codes.
•    Make sure no information is missing.
•    Do not misuse modifiers.
•    Check for problems with the payer's system.
•    Work with coding professionals.

Coding tip: modifiers for a portion of the surgical package

•    While payment is coded in a global surgical package to include several aspects of the patient's care — preoperative visits, surgery, recovery — multiple physicians or specialists often provide that care. When the care is split, the article identifies Modifier 54 as providing surgical care only while Modifier 55 is providing postoperative management only.

Additional coding resources

7 of the most common ASC coding questions answered

How do GI coding changes affect the field? Reimbursement, technology, denials & more
 
11 esophagoscopy coding updates to know

2014 CPT code Medicare list updates: what do ASC leaders need to know

The new 2014 Medicare N1 codes: how will this affect your ASC?

Collections

3 ways to approach increasing patient financial responsibility

•    Estimate and communicate. Let patients know their estimated financial responsibility upfront. Open, honest communication increases the likelihood of receiving payment.
•    Don't chase payment. After explaining patient financial responsibility, collect a certain amount before the point of service.
•    Train staff members. Prepare your staff to communicate financial expectations to patients in a clear, courteous manner. Offer printed materials on patient responsibility and payment options.

More collections resources

The patient collections problem: how ASCs increase payment rates

New patient financing tool helps providers boost self-pay collections

5 solutions to generate improved ASC cash flow

EHR

4 questions to ask before purchasing an EHR

•    Are you ready to use an EHR? Physicians need the time to select the right EHR for their practices and the resources to fully integrate the new system into practice.
•    What are your expectations for the EHR? Low expectations will result in EHR underperformance, while expectations set too high will result in disappointment.
•     Will you be able to take advantage of EHR incentive money? Physician practices should ensure they understand Meaningful Use Measures and what is needed to meet them.
•    What is a practical plan to implement the EHR? While vendors can provide support for EHR implementation, the bulk of the responsibility lies with the practice. A plan must be in place before purchasing the system.

3 quick tips for ASC EHR selection

•    Define your goals for the EHR before beginning the search.
•    Choose a system with the ability to run and pull reports.
•    Don't forget that implementation is only a part of the process. The system will still need customization and maintenance.

2 tips for EHR implementation at ASCs

•    Understand the concepts of implementation and adoption. Implementation simply means beginning to use an EHR, while adoption means the system is used correctly and fully integrated into an ASC's workflow.
•    Set realistic goals. There are many considerations when selecting, implementing and adopting an EHR. Find the system that is right for your center's workflow and budget needs. Create a practical timeline for acquisition, implementation and adoption.

5 ways to make sure your EHR is ready for ICD-10

•    Learn how ICD-10 will impact coding practices.
•    Press vendors on system readiness.
•    Review template and treatment plans.
•    Evaluate downstream billing impacts.
•    Don't skimp on training.

Additional EHR resources

EHR implementation time is now for ASCs: 7 key questions answered

Top 5 EHR implementation hurdles & how to avoid them

ICD-10

Budgeting for ICD-10: 10 things to know

Business processes (staff time):

•    Review and update prior authorization, referral process, utilization management.
•    Review and implement payer-specific medical policy.
•    Review and update payer contracts for diagnosis based reimbursement.
•    Review and update payer contracts for quality and/or performance-based reimbursement.
•    Review and update provider productivity measurement process.
•    Review and update paper superbills and other paper forms.
•    Review and update compliance processes .

Clinical processes:

•    Review provider documentation query process.
•    Review and make necessary updates to clinical documentation.
•    Purchase and implement computer-assisted coding.

ICD-10 preparation for small & medium physician practices: 7 actions to take now

•    Review ICD-10 resources from CMS, trade associations, payers and vendors.
•    Inform your staff of impending changes.
•    Bring together an ICD-10 project team.
•    Identify how ICD-10 will impact your practice.
•    Develop and complete an ICD-10 project plan for your practice.
•    Estimate and secure a budget.
•    Reach out to trading partners to understand their level of preparedness.

3 things to know about ICD-10 dual coding

•    Dual coding can be used during ICD-10 testing, but ICD-10 codes cannot be used for actual claims for dates of service prior to ICD-10 implementation.
•    After the ICD-10 implementation date, providers and payers will be required to use ICD-9 codes for services provided prior to the switch and ICD-10 codes for services provided on or after the switch.
•    HHS is expected to release a final rule setting the ICD-10 compliance date as Oct. 1, 2015. If so, ICD-9 codes would be used for services through Sept. 30, 2015 and ICD-10 codes would be used for any services provided after that date.

AMA: ICD-10 7 step training checklist

•    Identify all staff that needs to be trained.
•    Identify level of training required for each staff member.
•    Identify training formats that will work best for the staff.
•    Estimate training time and costs.
•    Identify where to obtain training.
•    Create a training timeline in relation to the implementation deadline.
•    Conduct staff training.

AAPC: 3 tips on selecting proper ICD-10 codes

•    Identify the condition in the alphabetic index.
•    Verify the code and find the highest level of specificity.
•    Review chapter-specific coding guidelines.

Additional ICD-10 resources

ICD-10 toolkit: 7 articles to prepare for October 2015

5 things to know about the new ICD-10 implementation date

AMA: ICD-10 impact assessment check list

From now until October 2015: the ASC ICD-10 implementation timeline

Avoiding ASC claims denials in the ICD-10 age: 8 key concepts

3 tips for ICD-10 transition in orthopedics

New payment models

3 tips for taking on pay-for-performance

•    Understand performance data and use it to set and meet benchmarks.
•    Select a practice management system with the ability to capture and analyze data.
•    Consult the practice's revenue cycle management company for guidance on pay-for-performance recommendations.

Dealing with the decline of fee-for-service reimbursement: 4 strategies

•    Increase utilization.
•     Step up collections.
•     Assess agreements.
•     Prepare for high deductibles.

Additional resources on new payment models

Narrow networks: ASC industry boon or bane?

Value-based payments: 6 important dates for gastroenterologists to know

Revenue cycle

AAPC: 3 tips for A/R success

•    Monitor time spent on appeals. Analyze appeals to identify any problems in policy or staff training.
•    Monitor individual payer contracts and reimbursement rates. Ensure proper payment is being received on each case.
•    Avoid writing off denials without a supervising signature. Denials that are incorrectly signed off on will lead to lost revenue.

3 ways to overcome ASC revenue cycle management challenges

•    Train front-desk staff to discuss collections issues with patients.
•    Invest in online payment options for patients.
•    Set aside revenue to invest in improving revenue cycle management practices.

10 strategies to improve revenue cycle management

•    Recognize where the cycle starts.
•    Focus on accuracy.
•    Submit claims daily.
•    Employ technology appropriately and don't overlook staff training.
•    Stay current regulatory coding and billing changes.
•    Leverage payer contracts to improve billing performance.
•    Ask for the patient's help when something goes wrong in the billing process.
•    Prioritize insurance invoices and patient balances.
•    Monitor the progress of pending issues.
•    Monitor payments closely.

Additional revenue cycle management resources

12 statistics for ASC revenue cycle management

4 of the most common pitfalls in ASC revenue cycle

5 ideas to avoid claim denials & keep ASC revenue cycle efficient through ICD-10

Overcome big revenue cycle management obstacles: trends & analysis for ASCs

9 threats to ASC revenue cycle management success

5 key ASC revenue cycle management performance indicators

More Articles on Coding and Billing:
Narrow networks: ASC industry boon or bane?
18 statistics on payer mix by ASC size
Partnership pitfall: what happens to ASC software after joint venturing?

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