ment system to inform billing that the block was performed. The billing team also can review anesthesia pro- vider reports to identify when pain blocks were ordered and reconcile the charge accordingly. In all instances, it is essential for the surgeon's opera- tive note to detail that a pain block was ordered and the reason(s) why.

Improve Upfront Processes All ASCs experience denials. Even the best-performing ASCs will typically have a 5–10 percent initial denial rate. Submitting appeals and fighting denials should be built into the revenue cycle process, and an ASC’s denial write-off percentage should be less than 1 per- cent. ASCs should rarely fail in their efforts to get paid for denied claims. Even an ASC that enjoys a write-

off rate that low should strive to avoid future denials. My mantra is that ASCs should always try to sub- mit a clean claim because it usually takes extensive time and resources to rework a claim. Essential to achieving this objective are strong upfront pro- cesses. One upfront area where ASCs can come up short is misunderstanding payer clinical policy requirements. For example, at least one national payer requires patients to undergo a psychiatric evaluation before receiving a neurostimulator. A failure to ensure the patient

receives A final upfront issue that regularly

trips up ASCs concerns local cover- age determination (LCD) and medi- cal necessity requirements. For ASCs that do not address these upfront, a denial is inevitable. The cause of these issues is typically a matter of verbiage—more specifically, not including enough information in the operative note to code to the highest level of specificity. For example, documenting that a

Revenue cycle greatness should be the goal for all ASCs. The right people, processes and knowledge can make it achievable.”

— Angela Mattioda Surgical Notes

the evaluation

before getting the trial neurostimula- tor will likely lead to denied payment for the neurostimulator—potentially costing the ASC thousands of dollars. Ensure that your payers' clinical poli- cies are carefully reviewed and rere- viewed when updated, with all require- ments

concerning your procedures

understood and consistently followed by surgeons and staff. Another upfront process that can trigger denials concerns submission of patient medical records. Your rev- enue cycle management team should know which payers require medical

records with the submission of a claim and how those payers want records submitted. Some payers want records submitted with the claim. Others want them separately. In addition, ASCs should submit

medical records electronically through a payer's portal whenever possible. One reason this is preferable to sub- mitting via paper or a clearinghouse is that records submitted via a payer portal are assigned a tracking number that is given to the ASC. If the payer denies a claim due to lack of medi- cal records, the ASC can provide the tracking number, which should expe- dite the appeal. Without that tracking number, the ASC will likely need to resubmit the medical records, which takes time and delays payment by at least a few weeks.

patient received a lumbar injection is important, but that alone is likely not enough information. The operative note should include the specific level in the lumbar spine that received the injection. Doing so enables a coder to then issue a more specific ICD-10 code that will support medical neces- sity. Educating providers about what is needed to meet LCD and medi- cal necessity requirements will help ensure claims get paid.

Going for Greatness Working to take your revenue cycle performance from good to great is not just about growing your bottom line. Elevating performance will give you the ability to reward employ- ees more significantly and frequently, helping improve retention and perfor- mance; make ongoing capital invest- ments that improve quality of care and drive growth; and deliver increasing distributions to owners. An elevated performance also helps ASCs reduce avoidable problems, which can cre- ate challenges for patients and require additional work for staff.

Revenue cycle greatness should be the goal for all ASCs. The right people, processes and knowledge can make it achievable.

Angela Mattioda is vice president of revenue cycle management services for Surgical Notes in Dallas, Texas. Write her at

ASC FOCUS MAY 2021 | 17

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