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Topic: Steps to securing appropriate orthopedic reimbursement

Ambulatory Surgery Reimbursement Update, June 3, 2008

The new ASC payment system bundles many orthopedic services that had been separately payable, and allows some separate payments for ancillary services that were once packaged. In an April 2 HCPro audioconference, “ASC Orthopedic Changes: Confront Coding and Financial Repercussions of the Final Rule,” Christi Sarasin, CCS, CPC-H, FCS, a consultant and CEO of Sarasin Consulting Group in Friendship, MD, discussed ways to take advantage of these changes and ensure full reimbursement.

Form a plan of action

To avert any risk of missed reimbursement for orthopedics, implement a plan of action so your staff members are aware of the changes, Sarasin said. Take the following steps:

  • Identify your risk areas and those procedures that you perform on a regular basis and what necessitates reporting a procedure completely.
  • Educate staff members responsible for documenting, coding, charging, and billing.
  • Audit any claim that has an “inpatient only” edit or an unlisted CPT code.
  • Audit modifier usage to ensure that coders and billers appropriately appended all modifiers.
  • Look at your final payment. “Just because you got paid for it does not necessarily mean you should have been paid for it, and there is always the chance that CMS is going to come looking for their money,” Sarasin said. “And when they come looking for their money, they usually want interest to go with it.”
  • Communicate audit findings to your staff, and conduct follow-up audits to ensure that you maintain compliance.

    Editor’s note: This topic is from the June 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider. For more information about the April 2 audioconference, “ASC Orthopedic Changes: Confront Coding and Financial Repercussions of the Final Rule,” click here.

     

     

     

     

     

     

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