1. Do the research on coding for each specialty. Though coding and billing in general is similar regardless of specialty, your coder, depending on their certification and experience, may need to do some extra research to learn the codes for your center’s specialties. With specialties like ophthalmology and ENT, Ms. Tude Thuot says coding is quite repetitive for outpatient surgery. Other specialties, such as orthopedics, can have more complicated coding practices.
In order to make sure your coder is using the right codes for complicated procedures, you should research codes descriptors and consult your physicians if necessary. “You can also encourage your physicians to talk to the coder. In our facility, if they have a question, they will ask, ‘If I do these procedures together, how does that effect our reimbursement?'” Ms. Tude Thuot says. Communication between providers and coders will help you avoid coding errors and increase the body of knowledge on both sides.
Ms. Tude Thuot also strongly recommends that frequent audits are performed on the coding and billing of the center. These audits can be internal and performed by the administrator or performed by an outside source such as an accountant or auditing service.
2. Keep up-to-date on your most profitable cases. Your administrator should be knowledgeable of the costs of the cases being performed in your center. He or she should have a strong understanding of coding and billing and consistently communicate with the business office staff regarding insurance eligibility, reimbursements and any denials, in addition to understanding your insurance contracts. This will be important in recognizing the procedures that are most profitable for your center. “Especially with some of the more expensive cases like in orthopedics, if physicians are going to remove or add hardware, you need to know the true cost of the case,” Ms. Tude Thuot says. “Sometimes you will find the cost of the implants is more than what you will be reimbursed on the case.”
Once you have a general idea of the most profitable cases for your center, involve your physicians. “If we have a unique case, a surgeon will call over and say, ‘We’re thinking of doing this. Can you tell me what our reimbursement is?'” she says. “I’m happy to do some cases that are a break even, but we can make [that informed decision] by knowing up front what it’s going to cost us and what we’re going to be paid. Our goal is to provide quality, affordable outpatient care, but we are still a business and knowing our costs is critical to that.”
3. Base your case scheduling on procedure type. If your multi-specialty ASC is trying to add case volume, you may run into scheduling challenges. “For example, we have ENT every morning in one of the ORs, we have another OR that we use primarily for conscious sedation cases thus that leaves us with only one remaining OR to start at 7:30am for the more complex plastic, orthopedic or general surgery cases we perform,” Ms. Tude Thuot says.
Cases that have longer recovery time are best scheduled as the first cases of the day, which can be a challenge in a multi-specialty center. According to Ms. Tude Thuot, it is optimal to schedule cases requiring less recovery time in the afternoon allowing for the more involved cases to be done in the morning. She says a center should consider the type of procedure, time in the OR and the expected recovery time as well as the type of patient when creating their block schedule.
