3 Tips to Maximize Surgery Center Billing and Coding

Regent RCM’s gold standard for days outstanding is 30 days or less, although the right number for a center could range from the mid- to high teens all the way up to 50, depending on payer mix and case mix. In this blog post, we’ve summarized 3 ways to keep days outstanding in check.

Manage Lags and Turnaround Time

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. Managing lags and turnaround time is one of the easiest ways to decrease your days outstanding. “The charge entry lag is measured from the date of service to the date charges are entered. The charge entry lag should be less than five days, with the gold standard being less than two and a half days.” Said Erin Petrie, Regent RCM’s Director of Revenue Cycle Management.

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 using an outside firm. By doing so, 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 be given a chance to rebut coding inaccuracies found during an audit,” said Petrie.

Some disparities found during our coding audits center around what was performed during the procedure and what was dictated. Sound coding practice is to always code from the operative report and not from the procedure.

Choose the Right Clearinghouse

Choosing the right clearinghouse can make a significant difference in the efficiency of your business office. Most clearinghouses can send electronic claims and receive electronic remittance (ERA). ZirMed and others set themselves apart by performing electronic eligibility in either batch or individual mode, providing real-time statuses and having 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 RCM’s expert billing and coding services for ASCs