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:
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.