Auditing - Final Step to Zero Denials for ASCs

June 14, 2016

Auditing-Final step to zero denials for ASCs

With the healthcare industry undergoing a regular change, it is extremely important for ASCs (Ambulatory Surgical Centers) to conduct regular audits for reducing denials and maximizing compensation. The results of these audits can be put to use by the billing and coding staff of ASCs wherein they can work towards improving reimbursements and the strengthening of ASCs compliance plans. Audits also lead to attaining zero denials as well trained billing and coding staff are aware of the latest rules and guidelines; they identify the common causes or denials/rejections and billing/coding errors and work towards eliminating them, reduce weaknesses of the system, and improve the ASCs strengths for better returns.

ASCs must understand the importance of auditing in their revenue cycle management. Annual audits must be conducted for two reasons: purpose and communication. Staffing, coding, workflow, processes and reimbursements must be audited for the functioning of the ASCs. Again, communication must be open for auditing and feedbacks that must be taken seriously to eliminate errors. The factors to be considered while auditing coding are:

  • Accuracy of codes :-  Correctness in CPT codes, modifiers and diagnosis codes and the need for additional ones to be placed / updated. Coding accuracy should be checked by coders through a CPT chart audit.
  • Auditing collections:- Check if the first follow up has taken place within 15-30 days, along with an additional follow up every 30 days. These should be coupled with follow-up notes. Also to be checked is appeals which should be prepared and done precisely. Check if the claim or the patient statement has been generated along with efforts made towards pre-collections (a strong claims process results in increase cash flow).
  • Charge posting:- Check if the diagnosis codes, modifiers and charges have been posted correctly. Review of up-front adjustments which should have been done properly along with an assessment on the number of days taken to create and produce a claim after receiving from the coder.
  • Payment postings:- These must be audited on the following parameters: payments and appropriate notes posted, adjustments made along with balance transferred in addition to credit balance processed on time, and other payments (under/over) handled well in time.

The payment postings department must have an understanding of contracts, highlight the cases not followed correctly and mark the A/R department to follow up on denials. Follow-up processes ensure billing matter are tackled and ensure all denials are resolved timely to avoid a loss in revenues. Auditing aids in zero denials as ASCs would ensure compliances and follow the latest rules and guidelines. Identification of errors can prevent the ASCs from committing the same error the next time. Regular auditing can ensure that ASCs regularly update their documentation such as detailed and personalized reports for individuals rather than relying on cloned or canned reports.

Appropriate coding should ensure highest specificity and correspond with the procedure conducted, thereby reducing errors. Maximization of revenues is the key for ASCs survival which comes from regular internal or external auditing of revenue cycle functions such as billing and coding and reimbursement practices.


Category : Best Billing and Coding Practices