Tips for Proper Surgery Center Billing and Coding

The following article is written by Michael Orseno, revenue cycle director for Regent Surgical Health.

Proper billing and coding will help keep an ambulatory surgery center's days outstanding down. Here are a few tips to keep your business office efficient and your receivables in good shape.


Manage lags and turnaround time. One of the easiest ways to decrease your days outstanding is to manage your lags and turnaround time. The charge entry lag is measured from the date of service to the date charges are entered. This number should be less than five days, with the gold standard less than two and a half days. Claims should always be sent the same day charges are entered, so the claim lag should be the same as the charge lag. If centers are experiencing a significant difference between the two, this is an indication that your billing department may be holding claims or that they're entering charges prior to receiving the operative report.

Some centers have sound billing practices, but their charge lag suffers from slow turnaround times. For outsourced transcription and coding services there's an easy fix — demand 24-hour turnaround times. If either of them can't do this, then it may be time to look to other companies. Physicians not dictating in a timely manner is a much tougher problem to solve. Often it is only one or two physicians, and sometimes they're owners and/or board members. Strong policies and procedures may not be enough in these circumstances — it may be necessary to bring the statistics up in board meetings to exert peer pressure on the offending physicians. Or in extreme cases, a center may opt to impose fines and/or hold distributions.

Conduct periodic coding audits. It is extremely important to conduct periodic coding audits by an outside coding company, whether your center outsources its coding services or employs a certified coder. Regent coordinates bi-annual audits on all of our centers by a coding company called Campbell Wilson, whose only line of business is coding audits. That way we eliminate the conflict of interest a regular coding company may have in finding coding errors in the hopes of gaining additional clients. All centers should be held to an acceptable standard above 90 percent accuracy, but given a chance to rebut coding inaccuracies found during an audit.

Some disparities found during our coding audits center around what was performed during the procedure and what was dictated. A surgeon may have performed a right shoulder arthroscopy with open anterior reconstruction, but if the reconstruction was not dictated, it cannot be billed. Sound coding practice is to always code from the operative report and not from the procedure.

Clearinghouse. Choosing the right clearinghouse can make an enormous difference in the efficiency of your business office. Most clearinghouses today can send electronic claims and receive electronic remittance (ERA). Those that set themselves apart, such as ZirMed, perform electronic eligibility in either batch or individual mode, provide real-time claim status, and have the ability to setup center-defined, custom claim edits. In addition, ZirMed rolled out a new enhancement recently which allows some of our centers to send worker's comp claims, traditionally sent on paper, electronically by matching up a scanned operative report to the electronic claim. This has caused a decrease in our A/R greater than 90 days for worker's comp, which is habitually one of the more challenging financial classes.

Keeping days outstanding to a minimum is a worthy task for all ASCs, one that requires constant diligence and strong organizational efforts from everyone involved in the process. The fruits of this labor can lead to steadier collections, a more organized business office, and more integrity in your reporting data.


Learn more about Regent Surgical Health.

More Articles Featuring Regent Surgical Health:

From Surgery Center Administrator to Executive: 4 Industry Leaders Discuss Their Transition

10 Metrics for Measuring Physician Performance

Our Most Successful Turnaround: Thoughts From Regent Surgical Health COO Nap Gary

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