Billing tips

1. Understanding rules for implant billing. Most arthrodesis procedures require the use of an implant, so it is important to note the CPT code for such procedures usually exclude the cost of the implant, says Mona Kaul, chief coding and compliance officer of GENASCIS. Payors may require implants to be coded using separately identifiable HCPC level II codes.

Note: Some payors may require a copy of implant invoices to be sent with the claim. ASCs should identify which payors require such invoices to help ensure payors do not delay claims processing due to the lack of complete information.

2. Be prepared conversations with coders when a claim is denied. Practice coders should also know how to handle denied claims. Claims are denied for a multitude of reasons, and coders may need to refer back to physicians to get updated information. If a procedure is done differently than usual, the coder must know the reasoning behind this change to receive reimbursement from the insurance company. “If the surgery is done in a different anatomical position for one reason or another, there are different units for pain management reimbursement,” says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. “Make sure the coders know what you are doing because correct clinical documentation can speed up the payment process.”

An ongoing dialogue between coders and physicians is essential for an effective billing process. “The physician shouldn’t be surprised when they get questions from the coders,” says Mr. Gilbert. “Have a process in place for communication because billing and coding is complicated. There needs to be a dialogue in place for an effective billing process.”

3. Negotiate payor contracts with the future in mind. Set yourself up for the next contract during current negotiations, says Jim Odom of The C/N Group. Stay abreast of the ever-changing healthcare industry and know which types of procedures are profitable and how that may change. “If you position product lines you know are going to decline over the course of the current contract, establish a foundation now, so the pain is less when the contract kicks in down the road,” says Mr. Faith. Additionally, ask payors about their timeline for switching to the APC reimbursement model. “We’ve been listening to what they say and how they answer to position ourselves better for the future,” says Mr. Odom. “We ask the payor what they are talking about internally for one or two years down the road, such as which procedures are bring pushed into ASCs and which have pressure to be performed at hospitals.”

Business tips

4. Surround yourself with a good support staff. Physician leaders should surround themselves with a support staff that can ease the burden of their responsibilities. The partnering physicians should also consider compensating their leader for his or her role because the extra compensation will allow the physician to focus more on the needs of the whole group. Otherwise, the physicians are focused on bringing in cases for their compensation and are less likely to fully understand and take responsibility in the decisions they have to make.

5. Reward excellence among surgery center employees. When there is behavior that supports the surgery center’s values, you want to reward and recognize the people that exhibited such outstanding behavior: public rewards and recognition of outstanding behavior will send a clear message to the rest of the organization what is meant in the values statement, says Thomas Jacobs, CEO of MedHQ. This should not be arbitrary or inappropriate or limited to one select group of staff members. Anyone can exhibit behaviors that are observably supportive or in conflict with your company’s values and should be rewarded.

Recognition programs should not be too gimmicky and should serve to highlight those who exemplify your company’s core values. For example, companies can award pins to team members who have been identified by their peers for performing behaviors that are representative of one of the core values. These achievements can then be recognized at monthly staff meetings.

6. Network within the community through the Chamber of Commerce. One of the most important aspects of marketing an orthopedic practice is networking within the community and forming a relationship with the other healthcare providers in the area. By joining your chamber of commerce, physician leader will have access to information about events involving the healthcare community. They can also involve their medical staff and partnering physicians with outreach activities in order to create a greater understanding about community needs as well as administrative duties.

Related Articles on Orthopedic Surgeon Leaders:
5 Key Strategies for Effective Orthopedic Practice Leaders
6 Challenges for Orthopedic Physician Leaders
5 Things to Know About Online Orthopedic Practice Promotion