David Lau, managing partner of Medical Forefronts Financial Services, a management company that specializes in surgery billing for facilities featuring orthopedic and pain management physicians and practices, discusses four ways orthopedic practices can ensure success with their billing and coding process.
1. Make sure outsourcing companies work on accounts receivable. When your orthopedic practice outsources billing responsibilities to another company, make sure that company goes after the accounts receivable. "These companies are good at coding and sending claims out the door, essentially collecting the 'lowest-hanging fruit,' but you don't always know how good they are at chasing after more elusive A/R," says Mr. Lau. Ask the billing company upfront about their process for appealing or re-submitting denied claims to make sure you are receiving adequate reimbursement for the cases at your practice.
2. Don't rely only on technology to ensure correct coding. Electronic medical records (EMR) are becoming the wave of the future for many healthcare providers, and one of their functions is automating the surgeon's dictation and generating a report. While EMRs can be great tools for helping surgeons do many things efficiently, surgeons can't assume the software is able to correctly code a claim 100 percent of the time. "Not every surgical possibility is necessarily represented in the program, and surgeons need to consider that," says Mr. Lau. "People are anxiously subscribing to this new technology, which simply may not yet be ready."
For example, when surgeons do arthroscopic knee surgery, they might perform five procedures in two compartments. Using the EMR software, surgeons may be limited to pre-populated "drop-down menu" choices and thus, not be able to specify that a number of procedures were performed in one compartment and then another. In this case, the overgeneralization forced by the EMR menu would significantly change how this procedure is coded and subsequently reimbursed. Surgeons must be familiar with how CPT codes are generated from their dictation and how that can affect the bottom line.
3. Keep up with billing efficiencies. It's easy to become stuck in old work habits, and the billing process your practice has used for the past 20 years may no longer be efficient. Inefficiencies in revenue cycle management cost orthopedic practices time and money spent on manpower and materials, so practice staff must be willing to make changes in their everyday process. "There are a lot of old, less-relevant practices that tie up a lot of work cycles and can contribute to a lot of problematic claim generation," says Mr. Lau. Consider bringing in a consulting company to assess your billing process and make an effort to accept their guidance.
4. Stay updated on new regulations and codes. It's necessary for coders to have updated training on coding changes throughout their careers to ensure claims are correctly processed. When it's appropriate, coders should also share updates with the surgeons to optimize their reports and cut down on extraneous work. For example, a surgeon who isn't updated on the codes might spend hours writing medical necessity letters to go along with the claims when all they need to do is enter a new code.
"With all the changes coming up, it's difficult to be an expert at coding and all-things-billing," Mr. Lau says. "But now, more than ever, it's about aligning yourself with people in the industry who do know what they are talking about and can best serve your interests."
Articles Related to Orthopedic Practice Revenue Cycle:
4 Tips for Tackling Orthopedic Practice Revenue Cycle Management
4 Technologies to Improve Orthopedic Practice Revenue Cycle Management
7 Steps to Improve the Financial Performance of Orthopedic Practices
1. Make sure outsourcing companies work on accounts receivable. When your orthopedic practice outsources billing responsibilities to another company, make sure that company goes after the accounts receivable. "These companies are good at coding and sending claims out the door, essentially collecting the 'lowest-hanging fruit,' but you don't always know how good they are at chasing after more elusive A/R," says Mr. Lau. Ask the billing company upfront about their process for appealing or re-submitting denied claims to make sure you are receiving adequate reimbursement for the cases at your practice.
2. Don't rely only on technology to ensure correct coding. Electronic medical records (EMR) are becoming the wave of the future for many healthcare providers, and one of their functions is automating the surgeon's dictation and generating a report. While EMRs can be great tools for helping surgeons do many things efficiently, surgeons can't assume the software is able to correctly code a claim 100 percent of the time. "Not every surgical possibility is necessarily represented in the program, and surgeons need to consider that," says Mr. Lau. "People are anxiously subscribing to this new technology, which simply may not yet be ready."
For example, when surgeons do arthroscopic knee surgery, they might perform five procedures in two compartments. Using the EMR software, surgeons may be limited to pre-populated "drop-down menu" choices and thus, not be able to specify that a number of procedures were performed in one compartment and then another. In this case, the overgeneralization forced by the EMR menu would significantly change how this procedure is coded and subsequently reimbursed. Surgeons must be familiar with how CPT codes are generated from their dictation and how that can affect the bottom line.
3. Keep up with billing efficiencies. It's easy to become stuck in old work habits, and the billing process your practice has used for the past 20 years may no longer be efficient. Inefficiencies in revenue cycle management cost orthopedic practices time and money spent on manpower and materials, so practice staff must be willing to make changes in their everyday process. "There are a lot of old, less-relevant practices that tie up a lot of work cycles and can contribute to a lot of problematic claim generation," says Mr. Lau. Consider bringing in a consulting company to assess your billing process and make an effort to accept their guidance.
4. Stay updated on new regulations and codes. It's necessary for coders to have updated training on coding changes throughout their careers to ensure claims are correctly processed. When it's appropriate, coders should also share updates with the surgeons to optimize their reports and cut down on extraneous work. For example, a surgeon who isn't updated on the codes might spend hours writing medical necessity letters to go along with the claims when all they need to do is enter a new code.
"With all the changes coming up, it's difficult to be an expert at coding and all-things-billing," Mr. Lau says. "But now, more than ever, it's about aligning yourself with people in the industry who do know what they are talking about and can best serve your interests."
Articles Related to Orthopedic Practice Revenue Cycle:
4 Tips for Tackling Orthopedic Practice Revenue Cycle Management
4 Technologies to Improve Orthopedic Practice Revenue Cycle Management
7 Steps to Improve the Financial Performance of Orthopedic Practices