4 Coding & Billing Best Practices

Erin Petrie, Director of Revenue Cycle Management at Regent RCM, has worked in the medical field for nearly a decade, specializing in hospital administration and revenue cycle management. She draws from her experience to share best practices to help billers and coders manage a successful revenue flow.

  1. Verify patient information.

Prepare or update patient files in advance of their appointments. Check benefits and eligibility, making sure you have accurate information on factors such as copayments, deductibles, and balances due. Patients aren’t always aware of details related to their medical insurance – for example, if their employer has switched insurance companies, or if they need a referral from their general practitioner before seeing a specialist. Verify that the procedure code is billable under the patient’s insurance plan.

  1. Clarify patient financial responsibility.

Train your staff to communicate with patients about what payments they are responsible for. Make your ASC’s payment policies clear; ask front desk staff to confirm them when scheduling appointments, and post them in a visible area near check-in. Collect copay or co-insurance from patients at the time of service, and require payments toward past balances before scheduling new procedures.

  1. Submit correct claims the first time.

Be meticulous in producing error-free claims. Submitting an insurance claim, only to have it rejected, fixed, and resubmitted, can delay a payment by weeks or months. Avoid this frustrating cycle by double-checking claims for any errors in patient, provider, insurance, or billing information.

  1. Use proper codes and modifiers.

Go through each claim with a fine-tooth comb to confirm that you are using the appropriate codes for the services provided. Follow a standardized process to check information and minimize errors. Have you included all the necessary procedure and diagnosis documentation? Are you using the correct modifier for a procedure’s specific circumstances? Attention to detail in coding is critical for fast and accurate claims processing.

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ASC Business Office

How does proper charge entry affect an ASC’s financial performance?

Charge entry is considered one of the most critical stages in an ambulatory surgery center’s billing process. Best practices, including using modifiers correctly and performing regular business audits, should be followed and executed by knowledgeable experts to maximize revenue potential for the ASC.

Using modifiers correctly

Billers must confirm that not only the correct codes are inputted for each procedure performed, but also the correct modifiers are used. The two most common modifiers are 50, which is used for bilateral procedures performed during the same surgery, and 59, which indicates a procedure that is independent from other services performed on the same day. Inputting the correct modifier directly affects reimbursement so it is imperative to an ASC’s financial health that the biller gets it right the first time.

Performing regular business audits

Many billing and coding staff members are unaware of the importance of reading the full payer contract and how charge entry errors can affect the ASC’s financial performance. Performing a business office audit can help point out if there has been any lost revenue due to errors during the charge entry process. Audits should be performed regularly and errors should be reviewed so future revenue is not lost.

Impact on financial performance

Charge entry requires full understanding of payer contracts and billing s and is particularly important for ASCs with specialties like orthopedics, spine cases and pain management. Errors in the charge entry process can lead to lost revenue and directly impact an ASC’s overall financial performance.