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Topic: Develop strong billing strategies

Ambulatory Surgery Reimbursement Update, October 28, 2008

It is extremely important that your coding and billing staff members are up to date on all the payment changes and that they keep a close eye on denials and edits that come back from your clearinghouses, said John J. Goehle, MBA, CASC, CPA, vice president of finance at Facility Development & Management, LLC, in Orangeburg, NY in the August 13 HCPro, Inc., audio conference, “2009 ASC Proposed Rule: Prepare for Coding and Payment Changes.”

This helps ensure that payments to the facility are appropriate and that you give yourself the opportunity to follow up and contest any numbers that are not correct.

Look at comment indicators in the proposed rule in the Federal Register to help you focus on code changes that affect your facility, said Susan Garrison, CHCA, PCS, FCS, CPC, CPC-H, CCS-P, CHC, CPAR, executive vice president at Magnus Confidential, Inc., in Dawsonville, GA. She also spoke at the audio conference.

CMS uses the CH indicator in Addenda AA and BB in the proposed rule to indicate:

  • A new payment indicator is proposed for a Healthcare Common Procedure Coding System (HCPCS) code
  • A HCPCS code is proposed for addition to the list of procedures or services payable in ASCs
  • A HCPCS code is proposed for deletion at the end of the current calendar year

Follow up on explanations of benefits and don’t assume that your Medicare intermediary is always going to pay you appropriately.

Also, be sure to conduct coding and billing audits. Consider hiring someone to come in periodically to perform the audits. “This is a good way to catch errors,” said Goehle, “not only to make sure that you’re compliant from a legal perspective, but also to make sure you’re not leaving any money on the table and not overbilling.”

Editor’s note: This topic is from the October 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.

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