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billingBy Rhonda Hixson, Director, Product Management, AmkaiOffice, AmkaiSolutions

An article recently appeared in Becker's ASC Review describing five frequent coding and billing errors that all ASCs should avoid.

Our clients greatly appreciate that the AmkaiOffice business management system and the AmkaiCharts EMR are able to prevent or greatly minimize all of these errors:

Poor Contracting

The first error discussed poor contracting. Use of the AmkaiOffice Cost Management module to perform regular reviews of payor contracts addresses this by providing the information needed to evaluate your current payment rates by payor.

For example, you should look for variances between payment rates by payors for the same procedures. Running the AmkaiOffice Group Costing Report with grouping by payor will show the different payment rates paid by carrier for the same procedures. To be even more accurate and ensure that you are comparing apples to apples, you can set "Match Procedures" to "Single Procedures Only". This will pull out only cases with one procedure and remove any skewing that may result due to multiple procedures billed or multiple procedure discounts applied to some cases and not others.

Mismatched Fees/Service Invoices

The next major billing/coding pitfall occurred when the physician practice billed for one procedure and the surgery center billed for a different procedure for the same patient. AmkaiSolutions recently released the AmkaiOffice add-on AmkaiLink™ Physician Portal. This web-based solution was designed to provide an electronic alternative for physicians offices to fax or phone in requests for OR or procedure room time appointments in an ASC. In addition to being able to download the surgery schedule directly from the portal, the Performed Cases option makes the billed surgical codes available to the physician practice and ensures matching of fee/service claims. This prevents both facility and professional claims from payor delays due to incorrect or misinterpreted coding. Any disagreement over the procedures/codes being billed can be discussed between the facility and the physician's office and adjusted accordingly.

Allowing Late Patient Pay

The next point related to obtaining money due from the patient upfront. When patients are added to the schedule and registration and insurance information has been entered into the AmkaiOffice system using the estimated revenue calculator, the patient's out-of-pocket payment is determined. Adding this amount to the deposit field on the verification screen ensures that the amount to be collected is displayed in the arrival/departure screen when the patient is checked in. You can run the "Demographics Form > Patient Summary" and send a letter to patients prior to their date of service to further ensure there is no miscommunication on the payment amount expected when patients are checked in for service.

Not Filing Claims On Time

Issue four deals with timely filing of claims and the delays that can result from slow receipt of operative notes. AmkaiCharts provides several quick and easy solutions to physicians for generating operative notes immediately following completion of surgery. This, along with task management lists for tracking dictation, can help manage the processing and timely approval of the operative note.

Life Cycle reporting in AmkaiOffice can also help to define where a facility's bottlenecks may be in processing claims. This report provides information on: 1) how long it takes to post charges following date of service; 2) how long it takes to generate a claim after charges are posted; 3) time to first payment once the claim is filed; and 4) time to bring the balance to zero. When run over a period of several months, the report gives a clear picture of where the process may be slowing down and which providers, payors or billers may be causing the slowdown.

Inaccurate Dictation Can Lead to Underbilling or Overbilling

The final discussion point in the article examined poor coding due to inaccurate dictation. AmkaiCharts provides options other than dictation to create timely and accurate operative notes. This can result in more accurate coding, more timely charge posting and claims being paid on first submission.