COVER STORY


and a tight revenue cycle, says Lori Tamburo, CASC, administrator of Sheridan Surgical Center in Sheridan, Wyoming.


“Use CQI measures


(continuous quality improvement) to study how many procedures are being rejected, when and why. Use that to improve your coding. Claim rejections are extremely time consuming and very costly to ASCs.” It is common for op reports to delay


the ASC billing process, not the coding, Tamburo says. “To effectively manage that, it starts with the coder who needs to make sure that the op reports come in on time and then turn them around quickly. Claims need to go out within 24–48 hours of the surgery to ensure that revenue cycle stays tight.” Sheridan Surgical Center is explor-


ing a program that lets doctors dictate and then transcribes and codes the same day, Tamburo says. “Streamlin- ing your dictation and transcription to coincide with your coding would be important to ensure timely payment. We do our own billing but outsource the coding and transcription.” It is also important to have coding audits at least once a year, Tamburo says. “We take sample cases and send to an independent coder to see if they match. That way, you maximize the revenue that you receive on every case. “Facilities should pursue having a


certified professional coder,” Tamburo adds. “It would add value to the position.”


Outsourcing All facilities are not created equal, therefore, outsourcing is a decision that should be made on the needs of a facility, Kelly says. “When you have a small business office and you either cannot find a coder or it does not make sense fiscally to hire one, outsource,” Ellis says. “Most professional coders don’t prefer doing billing. If you make them, they might not want to stay. If you have that situation or if there is too much vol-


14 ASC FOCUS APRIL 2016


When you have a small business office and you either cannot find a coder or it does not make sense fiscally to hire one, outsource.”


— Stephanie Ellis, RN Ellis Medical Consulting Inc.


ume to have someone doing both, out- source the coding.” Low-volume centers tend to have coders do both coding and billing, but if they can’t find someone who can do both, hiring a biller and outsourcing the coding might make more sense, Ellis says. High-volume centers usually have separate people doing coding and billing. If they can’t find a good coder, they might outsource. “It also makes sense to outsource in the interim when your coder’s going on vacation or is out sick,” Ellis says. Start-up ASCs that don’t have the initial case load volume to hire a full- time coder might opt to outsource coding until their volume increases,


Bentin says. “Also, if you don’t want the overhead of a full-time coder, a facility might want to outsource,” she


says. “Sending coding to an


outside company puts the liability on that company as far as accuracy is concerned, and it lowers your overhead. However, the ASC should understand that if the external coding company codes incorrectly and the facility submits the claim, the facility is accountable for any inaccurate claims submissions as the coding company partner.” If you outsource, keep the turn- around time in mind, Tamburo says. “We don’t have any internal coders that are trained and specialized, so we outsource,” she says. “The fee associ- ated with outsourcing and the lag time can make the process very expensive. We pay our coders hourly fees and we scan our documents to them. If some- thing does not scan correctly, it has to be resubmitted, which causes a delay in coding and billing.”


Before picking an outsourcing


coder, do your homework to make the best decision for your facility, Kelly says. “Ask sister facilities within your health care management company and/ or the ASC community if they use an outsourced coding company. If they do, get their honest opinions.” Do not just go with price when outsourcing,


Ellis cautions. “There


is a very big difference with quality between different coding companies,” she says. “You get what you pay for. ASCA has a vendor list that is a good source. Reputation is important.” Kelly adds, “I have outsourced coding for my multi-specialty ASC for 7+ years


without any regrets.


Outsourcing has been one of the best decisions that I have made as it fits our needs and they consistently provide an outstanding service.”


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