CODING
tient department (HOPD) may per- form the same procedure, coding practices for these two facilities are considerably different. Sophisticated payers today understand these differ- ences; they also understand coders frequently make mistakes because of those differences. Payers performing audits to verify submitted claims typically request all necessary supporting documentation, including invoices, OP notes, pathology reports and test results. In return, admin- istrators should request a full summary of post-audit findings. This last step will help an ASC prepare for future audits.
Coder Education Not all coders fare well on these assessments, but that does not mean they are necessarily poor performers or bad employees. They might just need some brushing up in a specific area or two—and it is important for employers and employees alike to recognize this.
Generally, coders who do not meet the industry standard of 95 per- cent accuracy should receive addi- tional training. In many cases, those who score in the low to mid-90s will need to address only a single issue to meet the 95 percent threshold. Indi- viduals who score in the 80 percent
range are doing many things right but should focus on individual spe- cialties and receive supplemental training. Coders who score below 80 percent should be given immedi- ate training and mentoring. A coding error can result in upcoding, mean- ing an ASC could later owe pay- ers money, or undercoding, where a facility could potentially be losing out on thousands of dollars. Many hospitals, local tech schools
and universities offer training pro- grams, and there are an abundance of resources available online. Typi- cally, coders receive additional help through anatomy, physiology or med- ical
terminology courses. In
other
cases, coders might need to earn a coding certification if they do not already have one or look at gaining additional certifications such as the ASC specialty certification.
Benefits of Conducting Regular Audits
On October 1, 2016, the Centers for Medicare & Medicaid Services (CMS) ceased its year-long ICD-10 grace period. Moving forward, coders must use the highest level of specificity to remain compliant. As the health care industry continues to evolve, maintain- ing a robust revenue cycle starts with coding accuracy and compliance. Coding mistakes can result in sig- nificant revenue loss and compli- ance violations, and without regularly scheduled audits, coders can continue to make the same mistakes indefinitely. Taking time to analyze final results and apply the lessons learned will help coders and auditors both grow and improve professionally and play an important role in creating a financially successful facility.
Jessica Edmiston is a senior vice president at National Medical Billing Services in St. Louis, Missouri. Write her at jessica.edmiston@
nationalASCbilling.com.
20 ASC FOCUS JANUARY 2017
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