When an ASC receives a letter of demand, you have the opportunity to converse with the auditors and contest the fee. Coders must be able to defend their work by pointing to the operative documentation and coding guidelines. Right now, RACs seem to be identifying claims with the same CPT coded twice as mistakes. There are some occasions where capturing the same code twice is appropriate, and identifying those instances will become increasingly important in the future.
To avoid coding mistakes, Ms. Bentin recommends:
• Conducting internal audits
• Giving staff members appropriate time to analyze claims before they are sent out
• Continuing education courses for coders
It’s imperative that coders aren’t rushed to finish a quota of claims because they need to have time to make sure claims are accurate. Coders must be able to decipher Medicare from commercial payor claims and understand the utilization of Medicare edits. Surgeons also need to write clear operative notes and be ready for a conversation with coders about the specificities of unusual or complex cases.
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