Reasons to Outsource

4 Steps of a Regent RCM Business Office Audit

A Regent Revenue Cycle Management (Regent RCM) audit goes beyond a traditional reimbursement assessment. “The benefits of an audit are clear,” said Michael Orseno, VP of Revenue Cycle at Regent RCM, “and we ensure that facility time commitment is minimal. Our ASC-specific expertise allows us to complete the process in about two weeks.”

This is a quick turnaround, particularly considering the potential upside. In the case of one client, a business office audit uncovered coding errors which led to recouping more than $590,000 in additional funds.

An audit is comprised of four steps:

  • Initial Data Request*. Access to information is vital, and centers will provide a variety of data including but not limited to year-to-date case count and payer mix.
  • Initial Analysis. After collecting and reviewing initial data, Regent RCM selects multiple cases for a more detailed review and analysis.
  • Full Analysis. Pinpointing a number of cases, the Regent RCM team dives deeper using an internal audit tool set.
  • Once the audit is complete, Regent RCM will present findings on-site and provide detailed, strategic recommendations to ASC leadership.

In an upcoming blog, Regent RCM will further define the four key components of an audit including reimbursement, coding, staffing and observation (workflow and process).

Ready to get started? Call Regent RCM’s dedicated team today (312) 882-7228 to schedule an audit for your center.

Insurance coding statement

Four Additional ICD-10 Coding Tips

Building on a recent ICD-10 coding post, Mary Bort, Director of Coding at Surgical Notes, MDP, LP, and Regent RCM coding partner, shares four more coding tips aimed at helping ASCs succeed while implementing new ICD-10 codes.

  1. Claim Rejection for CMS

The procedures for correcting and resubmitting rejected claims and issues related to denied claims have not changed with ICD-10, so submitters should follow their existing billing procedures. CMS will not reject claims because of lack of specificity required for a National Coverage Determination (NCD), Local Coverage Determination (LCD) or other claim edit.

  1. Dates of Service

For outpatient and physician reporting, the proper CPT code set is driven by the date of service, NOT by the billing date. Claims for dates of service on and subsequent to October 1, 2015 must be coded in ICD-10. Claims for dates of service prior to October 1, 2015 must be coded in ICD-9 – any claims for dates of service after October 1, 2015 that contain ICD-9 codes will be rejected. There is no dual code reporting, so claims cannot contain both ICD-9 and ICD-10 codes.

  1. HIPAA (Health Insurance Portability and Accountability Act of 1996)

While HIPAA covered entities are required to accept ICD-10 codes as of October 1, 2015, entities that are not covered under HIPAA are NOT required to accept ICD-10 codes.

Covered Under HIPAA:

  • CMS
  • Commercial payers such as Aetna, BCBS and United Healthcare
  • Federal payers such as Medicaid

Not covered under HIPAA:

  • Attorneys
  • Lien companies
  • Workers compensation carriers
  • Auto insurance

NOTE: According to iHeathBeat, California, Maryland, Louisiana and Montana will continue to use ICD-9 for Medicaid fee-for-service programs – Medicare has approved a delay for those state Medicaid programs due to inability to process ICD-10 codes. Other carriers will have to adhere to the rules if they are a HIPAA covered entity, regardless of the state.

  1. Types of Testing

If a center has not yet performed ICD-10 testing, it should perform content-based testing, internal, and external testing. Content-based testing can identify gaps in a center’s ICD-10 upgrades and should be performed to assess surgeons’ documentation and coders’ ability to code in ICD-10. Internal testing should be conducted to evaluate a practice’s ability to create and use ICD-10 codes throughout the patient workflow in place of ICD-9 codes. External testing should be performed with internal trading partners, such as billing service, clearinghouse and payers, to test a center’s ability to send and receive transactions that use ICD-10 testing. This will include acknowledgement testing and end-to-end testing.

The rapidly changing health care market presents both challenges and opportunities. Partners like Regent RCM and Surgical Notes can provide customized solutions and streamlined processes. Click here to contact Regent RCM and connect with an RCM expert or click here to contact Surgical Notes for coding or transcription specific questions.

Ed Tschan, Regent RCM Director of Business Development,
etschan@regentsurgicalhealth.com

Don Callender, Surgical Notes, Central Region Sales Director,
dcallender@surgicalnotes.com

Insurance coding statement

Four ICD-10 Coding Tips

ICD-10 is here – and Mary Bort, Director of Coding at Surgical Notes, MDP, LP, Regent RCM coding partner, weighs in and shares four coding tips to help ASCs succeed while putting new ICD-10 codes into practice.

  1. Up-to-date ICD-10 templates

To safeguard against claim rejection, verify that all of your templates (EMR’s, transcription, etc.) to confirm that they meet ICD-10 standards and comply with the specificity need for ICD-10 coding.  While this step should have taken place prior to ICD-10 going live, it is critical to update existing templates to me the new documentation requirements. This includes the features available in custom template designs that can better fit each health care organization’s workflow.

  1. Clinical documentation

The highest specificity of documentation should be used with the implementation of ICD-10. This does not mean that health care providers need to have an increased amount of documentation, but rather that the documentation is more precise including anatomical site or location, laterality and episode of care.

  1. Unspecified codes

As part of the ICD-10 Official Guidelines for Coding and Reporting, all HIPAA-covered entities must comply, however unspecified codes are still available when documentation does not support a higher level of specificity. The unspecified codes often have necessary and acceptable uses. For example, when sufficient clinical information is not known or available about a health condition, and the coder is unable to assign a more specific code, it is acceptable to report the appropriate “unspecified” code.

  1. Flexibility with family of codes

Family of codes refers to the three characters of an ICD-10 code. These are codes within the same category that are clinically related but provide differences in capturing specific information on the type of condition. For example, Crohn’s disease is in the K50 family. To include a Crohn’s disease diagnosis on a claim, a valid code must be selected. As long as the selected valid code is within the K50 family, then the audit flexibility applies.

With the challenges presented by the rapidly changing health care market, including documentation and coding challenges related to ICD-10, partners like Regent RCM can provide customized solutions and streamlined processes. Click here to contact Regent RCM and connect with an RCM expert or click here to contact Surgical Notes for coding or transcription specific information.

Ed Tschan, Regent RCM Director of Business Development, etschan@regentsurgicalhealth.com

Don Callender, Surgical Notes, Central Region Sales Director, DCallender@surgicalnotes.com