Tammy Luttenberger is the billing and collections manager for Hudson Valley Ambulatory Surgical Center in Middletown, N.Y., and Andrea Clark is the CEO of Health Revenue Assurance Holdings in Plantation, Fla.
Here are their five simple goals ambulatory surgery center billers and coders should set for themselves in 2013.
1. Review contracting. Your ASC has likely evolved throughout the past year. Revisit your contract to reflect adequate rates for your mix of cases and payors.
"In an ASC, good contracting can make or break a facility and there is always room to improve," Ms. Luttenberger says. "As we begin to bring new specialties on or perform new procedures, we need to look at our cases and make sure our contracts reflect the best rates without forgetting specific carve outs for certain procedures or high cost implants and supplies."
2. Prepare for ICD-10. The ICD-10 transition is on everyone's minds, and preparation for the transition should be a priority next year. Experts expect nearly 30,000 new coders will need to be hired to meet increased demands nationwide, and current coders will become less productive during the switch.
Preparation will be the best way to limit the risks expected with the switch.
"ICD-10 trained billers and coders will be vital to keeping ambulatory surgery centers' revenue afloat," Ms. Clark says. "If the ASC is not coding correctly under ICD-10 the day it takes effect, cash flow will come to an immediate halt, which is why training should be a primary goal in the New Year."
3. Calculate patient pay earlier. As more healthcare reforms kick in, patient deductible and out-of-pocket costs may start to increase. To best prepare your patients for their surgery, Ms. Luttenberger suggests calculating their pay portion two weeks in advance of the procedure.
Giving them additional notice will help patients to make payment arrangements with your ASC's billing department.
"One way we have effectively dealt with this is to offer our patients Care Credit," she says. "Care Credit offers the patient a healthcare credit card, interest-free for six months. We will continue to work with our patients to allow them to afford high-quality healthcare."
4. Obtain additional coding certifications. Quality measures will continue to be ramped up for ASCs. Coders and billers should seek additional coding certification to handle the new procedures and regulations, both for healthcare generally and for their specialty.
"It is common to see coders now with two or more certifications, and I believe that will increase," Ms. Luttenberger says. "It's important to maintain current credentials and consider adding more to verify our expertise."
5. Know what payor contracts will require of coders and billers. As ICD-10 approaches, ACS should review their managed care contracts to clarify exactly what payors expect from the new coding and billing. This can help center's figure out what additional training is necessary, Ms. Clark says.
"Currently, there are several commercial payors that require ASCs to report ICD-9-CM procedure codes on UB-04 claims and not CPT codes on the CMS 1500 claim form," she says. "ASCs need to determine if these payors will require ICD-10-PCS codes, in lieu of ICD-9-CM procedure codes, come Oct 1, 2014."
If this is the case, the amount of preparation required for the switch from ICD-9 will increase.
More Articles on Coding, Billing and Collections:
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Here are their five simple goals ambulatory surgery center billers and coders should set for themselves in 2013.
1. Review contracting. Your ASC has likely evolved throughout the past year. Revisit your contract to reflect adequate rates for your mix of cases and payors.
"In an ASC, good contracting can make or break a facility and there is always room to improve," Ms. Luttenberger says. "As we begin to bring new specialties on or perform new procedures, we need to look at our cases and make sure our contracts reflect the best rates without forgetting specific carve outs for certain procedures or high cost implants and supplies."
2. Prepare for ICD-10. The ICD-10 transition is on everyone's minds, and preparation for the transition should be a priority next year. Experts expect nearly 30,000 new coders will need to be hired to meet increased demands nationwide, and current coders will become less productive during the switch.
Preparation will be the best way to limit the risks expected with the switch.
"ICD-10 trained billers and coders will be vital to keeping ambulatory surgery centers' revenue afloat," Ms. Clark says. "If the ASC is not coding correctly under ICD-10 the day it takes effect, cash flow will come to an immediate halt, which is why training should be a primary goal in the New Year."
3. Calculate patient pay earlier. As more healthcare reforms kick in, patient deductible and out-of-pocket costs may start to increase. To best prepare your patients for their surgery, Ms. Luttenberger suggests calculating their pay portion two weeks in advance of the procedure.
Giving them additional notice will help patients to make payment arrangements with your ASC's billing department.
"One way we have effectively dealt with this is to offer our patients Care Credit," she says. "Care Credit offers the patient a healthcare credit card, interest-free for six months. We will continue to work with our patients to allow them to afford high-quality healthcare."
4. Obtain additional coding certifications. Quality measures will continue to be ramped up for ASCs. Coders and billers should seek additional coding certification to handle the new procedures and regulations, both for healthcare generally and for their specialty.
"It is common to see coders now with two or more certifications, and I believe that will increase," Ms. Luttenberger says. "It's important to maintain current credentials and consider adding more to verify our expertise."
5. Know what payor contracts will require of coders and billers. As ICD-10 approaches, ACS should review their managed care contracts to clarify exactly what payors expect from the new coding and billing. This can help center's figure out what additional training is necessary, Ms. Clark says.
"Currently, there are several commercial payors that require ASCs to report ICD-9-CM procedure codes on UB-04 claims and not CPT codes on the CMS 1500 claim form," she says. "ASCs need to determine if these payors will require ICD-10-PCS codes, in lieu of ICD-9-CM procedure codes, come Oct 1, 2014."
If this is the case, the amount of preparation required for the switch from ICD-9 will increase.
More Articles on Coding, Billing and Collections:
National Medical Billing Services' Tamara Wagner Presents at ASCA Seminar
Only Full Medicaid Expansions Will Receive 100% Federal Funding
RACs Have Record Collection Year, Pose Challenges for Coders