12 common coding and billing mistakes in ASCs

Here are a dozen of the issues Ms. Ellis discussed during the session. The following scenarios and events — whether involving coding, operative report documentation or billing — can prove problematic for ASCs.   

1. Billing for items not rendered or not properly documented.
2. Upcoding CPT procedure or diagnosis codes.
3. Using incorrect CPT codes for new technology.
4. Billing non-covered ASC services as covered services.
5. Billing improperly for “cancelled cases” versus “terminated cases.”
6. Place of service discrepancies on claims for surgeries performed in ASC facilities.
7. Improper unbundling of CPT procedure codes.
8. Splitting cases/dates on GI scope procedures.
9. Failing to refund credit balances in a timely manner.
10. Billing Medicare patients for procedures that are not covered by Medicare for performance in an ASC facility. (Ms. Ellis also advised attendees to note problems with skilled nursing facilities or hospice care: “It’s very important for schedulers to catch those cases, because you need to work out a financial arrangement with the SNF or hospice to get paid. When you try to bill Medicare, you will not be reimbursed by Medicare for cases from SNF or hospice.” Also, Ms. Ellis noted that ASCs cannot charge Medicare patients cash for procedures that are covered in another place of service that are not covered in ASC facilities.)
11. Changing the date of service on claims to correspond with coverage dates.
12. Use of signature stamps to authenticate documentation. (More specifically, Ms. Ellis noted a distinction between signature stamps to denote the date of service. The date of service on a stamper or label cannot suffice as the date of service a procedure was performed or a service was rendered. That date must be written or noted elsewhere on the operative report.)  

More articles on ASC coding and billing:
5 ASC coding & billing changes to anticipate in 2015
29 statistics on best insurers by geographic region & reimbursement
86 statistics on payer timeliness

At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.