Exceptional Coders | Innovative Technology

Your practice will experience revenue leakage starting the moment a patient schedules an appointment with you. Some of these leaks typically start out small but overtime they will make large dents within your practice. Below are some tips to help improve your rev cycle management system and prevent those leaks.

1. Patient Information: Acquiring accurate patient information will help reduce claim rejections due to ineligibility, patient not found, or service not authorized. Implement a checklist at your practices registration office to help insure accuracy. The staff member registering a patient should verify the patient’s information, take a photocopy of the patient’s insurance card, and review the patient’s insurance (optimally, this would be done before the physician sees the patient in order to avoid performing services that are not covered).

 

E/M coding has become the most frequently billed physician service, and auditors are taking notice of its popularity. There is a fine line to walk when it comes to Medical coding.  Frequent E/M coding errors occur when medical practices are either upcoding or undercoding. Upcoding increases the risk of audits. Coding too conservatively doesn’t protect your practice from audits, and it severely decreases your level of reimbursement. Here are some tips to help you stay on the straight and narrow:

 

1. Sending out Claims Under the Wrong Provider: Popular medical coding errors occur when nurse practitioners and physician assistants report services improperly. Often times NP’s or PA’s will send out claims under the physician’s name and National Provider Identifier, but if the patient was treated solely by the NP or PA, the claim should be billed under the mid-level practitioner’s name and NPI.

 

Who Participates in Medical Coding?

Coding is a team effort, with the certified medical coder leading the way.

 

Front Desk/Receptionist

Medical coding starts with a patient making an appointment to see their physician. The receptionist makes the appointment – without the appointment the coding process would fail to start.

 

Physician or Healthcare Provider

Next, is the physician, or healthcare provider. They diagnose the patient based on their symptoms (complaints), and in some cases blood tests, x-rays, or any number of other test(s).

 

Certified Medical Coder

Then the medical record makes its way to the certified medical coder. The coder translates the written clinical documents into codes. This coding process allows the physician or healthcare provider to receive payment for the services they have provided to the patient.

 

Too often Ambulatory Surgical Centers are ill prepared for an RAC audit. It is in the ASC’s best interest to have an ongoing process that prepares your center for possible audits. In order to successfully avoid an RAC audit your ASC needs to have detailed and accurate documentation. It is imperative that your center is accurately translating your medical records into standard medical coding. There are 3 steps your ASC should take to achieve accurate documentation and medical coding. 

1. Employ Medical Coding Professionals- The work of your medical coders will determine the likelihood of an RAC audit. Whether your ASC is hiring your own medical coders or if you are using an outside source, make sure they are extremely well trained. When an ASC is being audited there are 4 common problems centers have that result in poor findings:
   1. Defectively trained staff
   2. Staff lacks the time to medical code thoroughly
   3. Medical coders misinterpret rules
   4. ASC’s have frequent rotations of new staff

To avoid these common problems it might be in your ASC’s best interest to higher an outside source for medical coding.

Medical coding for Ambulatory Surgical Centers is a field that varies greatly from standard medical coding for hospitals and surgeons. ASC’s have a different set of regulations they need to follow. Some ASC’s may be inaccurately using the same codes that surgeon’s use, which may attract auditors and decrease reimbursement. When it comes to medical coding, ASC’s walk a fine line. Some procedures require ASC’s to follow the rules for physicians, while others require them to follow hospital rules, and some medical codes are unique to ASC’s. 

Because ASC medical coding is more complex than typical medical coding, well-trained ASC medical coders are hard to come by. Few ASC medical coders are certified, and even less have previous experience. Outsourcing medical coding is typically the most effective method ASC’s use. At Aviacode we have highly trained ASC certified medical coders. We also have a team of Quality Assurance Coders to make sure everything has been coded accurately.

Coding For Medicare

While an ASC is typically labeled as a facility service, Medicare requires ASC’s to send their bills to the professional fee payers while using a facility fee claim form.

In today’s economy, creating a profitable business is not always an easy task. Ambulatory Surgical Centers are not impervious to the challenges that many businesses face. In order for ASC’s to succeed they need to be continually working on improving their business. There are three important founding principles that will help create a profitable ASC. 

1. Financial Stability: Maintaining financial stability is easier said than done; it’s never something that can be permanently checked off of your list. It contains many processes that require active involvement. Start by creating a detailed budget for your ASC. Review your budget frequently and cut costs whenever possible. Do some research to discover the best prices for the supplies needed, and take advantage of sales your supply companies’ offer.

An important aspect of maintaining financial stability is reviewing where your revenue is coming from. Most of the income Ambulatory Surgical Centers produce is from insurance companies; because of this it is imperative that your company maximizes the benefits of medical coding. Expert medical coding is a requirement for a successful ASC. It can be dangerous for ASC’s to hire their own medical coders, because surgery centers have a distinct set of codes that vary from that of a typical hospital environment. Medical coders without this important knowledge will decrease reimbursement from insurance companies, increase claim denials, and may even send auditors knocking on your door to investigate your surgery center. Outsourcing medical coding removes these dangers from your ASC, and would likely improve insurance reimbursement rates. Outsourcing your medical coding would increase financial stability for your Ambulatory Surgical Center by decreasing the instability employees bring to the company, and it would save your company from having to payout multiple salaries/cost of benefits.

Many Ambulatory Surgical Centers have clinics located in rural and metropolitan areas. While this allows their patients easier access to their ASC it, may create some medical coding difficulties for the centers themselves.

It is extremely important to maintain medical coding consistency within your umbrella of surgical centers. Inconsistent medical coding typically indicates that some medical coders are billing out incorrect medical codes, or they are under coding, which prevents ASC’s from being reimbursed the full amount warranted. If these inconsistencies persist, auditors may find it necessary to investigate the facilities and increase claim denial. 

Fortunately we have discovered four important secrets to maintain medical coding consistencies:

1. Consistent Trainings- Because most Ambulatory Surgical Centers have clinics in both rural and metropolitan areas it is extremely important that your medical coders are receiving adequate training. Many medical coders that are hired on have different backgrounds and if you strictly rely on your medical coders’ previous experience, inconsistencies will persist. Create a training manual for all of your clinics to help your medical coders know how your ASC practices medical coding.

To keep your medical coders on the same page it would be a good idea to hold frequent meetings. To ensure each clinic is receiving consistent trainings hold these meetings with the entire flock of medical coders your ASC has employed. Each clinic can be tapped into these meetings through a conference call or any other adequate source of technology.

HIM Directors, VP of Rev Cycle, Coding Managers, etc. Have become inundated with medical coding companies claiming to have the secret sauce that will rid them of all their woes. Whether it be reducing backlogs, helping with denials, decreasing AR days, any medical coding company you speak with can make it all happen. The question becomes, how do you do it? What makes you different than every other company knocking on my door claiming they have 95% accuracy and 48 hour turnaround time? 

There are 3 key differentiators you should look for when evaluating a medical coding partner for your healthcare facility.

1. Coders - How good are they? Are they domestic certified coders with years of experience? Are they off-shore coders? Domestic doesn't always equal better, however, make sure you understand where your coders are, and their level of expertise. 

It’s Tuesday; Tiffany is the Director of HIM at a chain of surgical centers in the Eastern United States. Tiffany has been working tirelessly to replace one of her In-House medical coders who decided to start working from home for another company. Her search has been in vain as so many coders are choosing to work from home for more dollars than she has budget to offer. One of Tiffany’s fastest and most accurate medical coders walks up to her and tells her she is leaving effective immediately.

Why?

The workload has become overwhelming, and the benefits that once kept her working for Tiffany have been outweighed by the promises of higher wages and more freedom from other companies. Tiffany is now down 2 medical coders with a mounting backlog growing every minute.

Stephanie Cecchini, CPC, CEMC, CHISP, ICD 10 Trainer, VP Coding at Aviacode

While recently conducting an onsite audit of professional services (office visits and behavioral health claims), I was asked: “What is the most valuable resource to a healthcare practice.” My answer was, as it always is, “The Physician, of course.” The conversation sat with me for several days. Why is it that the physician, who is the number one producer of revenue, is also the first person to be required to jump through documentation hoops and reimbursement nuances that can be as clear as mud? Why are more medical coders not grabbing their ear? We all know, physicians like a resource that can simplify, demystify, and ease administrative burdens. There are new positions starting to really takeoff around the idea, such as the exploding use of scribes. Scribes, however, don’t usually understand medical coding. It’s the knowledge and action taken at the medical coder level that resonates in cash flow and compliance. Medical Coders are Health Information Managers (HIM). They are so often the bearers of “bad” news that some are shy to speak up for fear of upsetting the physician. Bridging that gap is necessary. Medical Coders need to know how to communicate effectively. So how can you be HIM…and heard?

There are many “best practices” Medical coders can take to communicate effectively. Typically, a physician will be more likely to listen and respond when you are able to communicate by both your actions and words of understanding of their needs, wants, and mindset. Our doctors are life-long learners, highly intelligent, and possess a deep appreciation for logic and reason. Physicians are naturally intuitive, some even feeling spiritually drawn to practice the art of medicine and healing. Generally hungry for and appreciative of tips and techniques in learning new skills, physicians crave correctness. Accurately documenting for coding and billing purposes can prove a frustrating dichotomy; it is both a challenge to achieve correctness, while also an intrusion that takes away from patient time. The right medical coder will communicate in a way that stimulates these traits and emotions.