1. Implement technology that eases revenue cycle management. There are several health technologies that have been designed to facilitate medical practices in managing their revenue cycles. One of these technologies includes code deciphering software. Dave Wold, CEO of Healthcare Information Services, says code deciphering software can help orthopedic and spine physicians identify the correct CPT codes if they do not have a professional coder on staff.
Coding software also allows the physician to design individual payor edits and regulations to ensure claims are appropriately filed and will not be returned. This eliminates the need for manually entering codes into the claims. For the best results, Mr. Wold suggests physicians speak with certified coders about key words to use in their reports for improved accuracy during the transcription between codes and physician documentation.
2. Use benchmarks. Practices often ask, “How do I know that the revenue cycle is well managed? What do I look for?” The practice needs to compare performance to benchmarks like these provided by the Medical Group Management Association:
• One common benchmark is the percent of billed dollars that remains uncollected after 120 days. The MGMA benchmark for orthopedic practices is 18 percent.
• Another benchmark is how quickly your receivables are turning over. That is, what is the average length of time between rendering the service and being paid? The MGMA benchmark is 41 days.
If the practice’s measurements are higher than either of those benchmarks, it will need to make improvements, says Mr. Wold.
3. Explain the billing process to patients. Patients may not be aware that they should expect more than one bill from multiple entities, including the ASC itself. Melody Winter-Jabeck, administrator at Ravine Way Surgery Center in Glenview, Ill., says ASCs patients can receive multiple bills from the physician, anesthesiologist and pathology services.
“At our ASC, we’re communicating with patients as soon as their case is booked by first providing them with a packet that includes ownership disclosure, general information about center and a sheet about billing coming out of our ASC as well as who else they might expect the bill from,” she says. “Because patients often think it’s simply one fee for surgery, it’s important they receive that packet of information.”
4. Amend documentation in writing. Mona Kaul, chief coding and compliance officer of GENASCIS, says if the coder has follow-up questions regarding the documentation within the medical record, clarification should be requested from the physician. All changes to the documentation must be made in writing and added to the patient’s record for possible future reference. Do not accept verbal direction as it may be subject to interpretation and is not part of the permanent medical record.
