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ASC Consulting Services
OFF-SITE ASC CODING
Ms. Jones provides off-site coding for ASCs that want to outsource the coding functions of their facility. All cases will be coded using the appropriate ICD-9-CM, CPT, HCPCS Level II, modifier, and correct coding initiative (CCI) bundling guidelines. The cases will be returned to the ASC within 1 – 2 days after receipt.
OFF-SITE or ON-SITE ASC
CODING AUDIT
Ms. Jones audits the ICD-9-CM, CPT, HCPCS Level II, and modifier codes assigned for ASC cases, using the medical record documentation, claim forms, and explanation of benefits notices/remittance advice statements.
NEW ASC CODING AND BILLING
IMPLEMENTATION ANALYSIS
ASC Participants (if hired at time of engagement): Administrator, Business Manager, Nurses, Registrars, Coders, Billers, Surgical Technicians, Compliance Officer.
Deliverable: The ASC will be left with a “New ASC Coding and Billing Action Plan” that lists the outstanding issues that need to be addressed for successful coding and billing.
Scope of Work: In the “New ASC Coding and Billing Implementation Analysis” the Consultant reviews the documents, guidelines, and other references with the ASC that must be addressed, complied with, and/or implemented for successful coding and billing of claims to all the ASC’s third-party payers.
PHASE 1 – Coding Issues:
1 or 2 DAYS [number of days depend on the specialty(ies) of the ASC]
- The New ASC’s Fee Schedule/Chargemaster
- Most Common Anticipated Diagnoses for the New ASC’s Patients
- Most Common Anticipated Procedures for the New ASC’s Patients
- Review of Official ICD-9-CM Diagnosis Coding Guidelines
- Review of Official CPT Coding Guidelines
- Review of Official Modifier Reporting Guidelines
- Review of Official HCPCS Level II Coding Guidelines
- Review of National Correct Coding Initiative (CCI) Edits/Unbundling Guidelines
- CASE STUDIES (review and coding of operative reports for cases similar to those that the ASC will perform if they have not yet opened for business)
PHASE 2 – Billing Issues:
1 or 2 DAYS [number of days depend on the specialty(ies) of the ASC]
- Review of Third-Party Payer Contractual Agreements (including carve-outs)
- Compliance with Third-Party Payer Billing Guidelines/Filing Requirements/Edits
- Job Description(s) and Continuing Education Standards for Staff Involved in Coding and Billing Processes
- Surgery Scheduling Process (ASC List Covered versus Non-Covered Procedures)
- Insurance Verification Process and Documentation (eg, Pre-certification)
- Calculation of Patient Liability (egs, Co-Payments, Co-Insurance, Deductible)
- Preparation and Flow of Patient Billing Packet (egs, Insurance Cards, Patient Liability Form, Financial Policy/Medical Release/Assignment of Benefits, Information of Separate Billing, Payment to Patient Form, Medicare Secondary Payer Questionnaire)
- Registration Form and Processes
- Medical Records Management (egs, creating new charts, documentation, filing, retrieval)
- Coding Responsibilities
- Posting of Charges
- Claims Submission (including HIPAA requirements)
- Patient Account Follow-up
- Insurance Follow-up
- Accounts Receivable Criteria and Reports (egs, Patient Aging and Insurance Aging)
- Collection Agency Contract Specifications
- Posting of Payment
- Accounts Payable Documentation and Reports (eg, Explanation of Benefits Notices)
- State ASC Reporting Requirements (if applicable)
- FASA Reporting Requirements
- State Department of Health ASC Licensing Regulations.
- Physical Walk-through To Simulate All Processes From Pre-Registration Through Payment Posting
ASC Coding and Billing Operations Review
ASC Participants: Administrator, Business Manager, Nurses, Registrars, Coders, Billers, Surgical Technicians, Compliance Officer.
Deliverable: A written report that contains: detailed comments for all recommended coding/modifier changes, as well as the strengths, data quality issues, and opportunities for improvement identified during the Operations Review.
Scope of Work: The “ASC Coding and Billing Operations Review” is designed, to evaluate and analyze the entire patient data flow process from registration to accounts payable, to determine whether the process results are optimal. The information gleaned from the review is also used to provide the Center with recommendations for any identified data quality issues. The Operations Review does more than identify issues; it assists with the solutions.
PHASE 1- Coding and Billing Review:
1 or 2 DAYS [number of days depend on the specialty(ies) of the ASC]
- Review a recent Claims Report detailing the type and frequency of procedures performed by CPT and HCPCS Level II codes.
- Review approximately 10 multi-payer records and their corresponding bills and remittance statements for each of the ASC’s specialties. For each record the following data must be provided if applicable: charge ticket, operative report, pathology report, invoice(s) for devices/implants,
- Review at least one record per specialty in which a prosthesis/implant was inserted during the surgery (the corresponding bills and remittance statements for these records will be needed as well).
- Identify medical records with missing or inappropriate: modifiers, ICD-9-CM diagnosis and procedure, CPT, and HCPCS Level II codes (as reported by the billing staff for facility component billing).
- Identify bills with coded data that does not agree with billing staff reported codes and/or modifiers assigned for the “review” records.
- Provide official coding guidelines and/or clinical references for any recommended changes to codes/modifiers for the “review” records.
PHASE 2 – Operations Review:
1 or 2 DAYS [number of days depend on the specialty(ies) of the ASC]
Review the most recent claim denials and appeals, and financial reports, such as:
Daily Accounting Journal; Insurance Aging and/or Patient Aging; Unpaid/Delinquent Claims Report; Underpaid Claims Report; Paid Claims Reimbursement Analysis;
Monthly Cash Balancing Report; Patient Refunds Report; Charges By Payor
Collections By Payor; Transaction Summary by Doctor; Procedures By CPT Code
Conduct a review of: coding policies and procedures, billing (data capture, code verification, supplemental billing data collection, coding edits, claims generation), claims tracking, and claims adjudication. Data to be reviewed will include: organizational chart for the ASC; information system Vendor’s current User’s Manual(s); all standardized forms that are used to collect patient financial information; blank copy of any charge tickets/encounter forms that are used; comprehensive listing of all third-party payers that the Center has billed and the re-billing timeframes for these third-party payers; all Provider Reimbursement Manuals, newsletters and bulletins that are on file for all third-party payers; current (if available) fee schedules for all third-party payers; third-party payer contractual agreements (including carve-outs); third-party payer billing guidelines/filing requirements/claims edits; job description(s) and continuing education standards for staff involved in coding and billing processes.
Review the coding, billing and claims processing policies and procedures manual(s) for the Center. Data to be reviewed will include: all policies and procedures that have been written for the billing process: from pre-registration/insurance verification to payment posting; Surgery Scheduling Policies and Procedures; Insurance Verification Policies and Procedures; All Documents in the Patient Billing Packets ; Copies of ALL Billing-Related Forms (from Insurance Verification to Posting); Medical Records Policies and Procedures; Coding Guidelines; Claims Processing Guidelines; Billing, Follow-up, Collections and Payment Posting Policies and Procedures.
Receive a demo of the information system(s) that the ASC uses for all processes from scheduling to payment posting.
PHASE 3 – Report Preparation:
1 or 2 DAYS [number of days depend on the specialty(ies) of the ASC]
ASC Chargemaster Review
ASC Participants: Administrator, Business Manager, Nurses, Registrars, Coders, Billers, Surgical Technicians, Compliance Officer.
Deliverables: a manually revised copy of the chargemaster will be left on-site at the conclusion of our engagement (for your reference as we finalize our report); a written final report and summary of findings, as well as an action plan and recommendations for implementation will be available approximately 4 weeks after completion of our on-site review.
Scope of Work: The “ASC Chargemaster Review” is designed to: ensure compliance with all payers’ coding and billing requirements and to improve the billing process; improve the charging and billing process; review the chargemaster for compliance issues that federal agencies require for the Medicare Program; ensure compliance with Medicare coverage requirements; Review/interview for any services that are being provided but not billed, and or billed inappropriately.
1 or 2 Days OFF-SITE- PHASE 1:
- Review (off-site) of the current chargemaster.
- Review the chargemaster for deleted or invalid CPT-4\HCPCS codes.
- Review the chargemaster for non-covered or non-reportable CPT-4\HCPCS codes using the current version of the Medicare Outpatient Code Editor (OCE) edits.
1 or 2 Days - PHASE 2:
- Interview key employees during our on-site review to assist us in determining the exact test, service, supply, or procedure that is being performed.
- Determine whether the CPT-4\HCPCS codes or services being provided are appropriate based on the descriptions provided.
- Recommend deletions, additions or other changes where necessary.
- Review the chargemaster for correct usage of revenue codes and proper correlation to certain CPT-4\HCPCS codes.
- Recommend the addition of codes if it appears that a service is being performed and the code is not currently a part of the chargemaster.
NOTE: We will use guidelines of the American Medical Association (CPT) and the Centers for Medicare and Medicaid Services (CMS) in performing our review.
1 or 2 Days - PHASE 3:
Preparation of a written final report and summary of findings, as well as an action plan and recommendations for implementation of the chargemaster review findings.
ASC Coding and Billing Training
ASC Participants: Administrator, Business Manager, Nurses, Registrars, Coders, Billers, Surgical Technicians, Compliance Officer.
Deliverable: A master copy of the training manual will be provided to the ASC to duplicate for each training participant. Continuing Education (CE) credits will also be provided from the American Health Information Management Association (AHIMA) and/or the American Academy of Procedural Coders (AAPC).
Scope of Work: A comprehensive training manual will be used to educate the staff about the official coding and billing guidelines for ICD-9-CM, CPT, HCPCS Level II, and modifier codes.
STANDARD TRAINING MANUALS USED
(Other Manuals Can Be Compiled Based on the ASC’s Needs):
ASC Clinic: Multi-Specialty Procedures - This multi-specialty resource is designed for Freestanding ambulatory surgery center (ASC) Managers (Business, Nurse, Reimbursement), Directors, Administrators, Coding Supervisors, Coding Specialists, and Billers. The contents include: Current Freestanding ASC Structure, Proposed Freestanding ASC Structure, Medicare Coding Requirements, Medicare Billing Requirements, Coding Ambulatory Surgery, How To Use CPT When Coding Ambulatory Surgery, and CPT Coding Guidelines By Body System (Integumentary, Musculoskeletal, Respiratory, Cardiovascular, Hemic and Lymphatic, Digestive System, Urinary, Male Genital, Female Genital, Maternity Care and Delivery, Endocrine, Nervous, Eye and Ocular Adnexa, Auditory). 2 or more training days.
ASC Clinic: Dermatology & Plastic Surgery - This resource is designed for all technical, clinical and managerial staff responsible for facility component freestanding ASC coding and billing. The contents include: exercises based on actual outpatient operative reports; and CPT coding guidelines for topics such as: tissue expander, pedicle flap, pressure ulcer, skin grafts, nail avulsion and excision, scar revision, burn treatment, lesion excisions, wound repair, adjacent tissue transfer/rearrangement, breast surgery, free flaps with microvascular anastomosis. 1 or more training days.
ASC Clinic: Eye & Oculoplastic Surgery - This resource is designed for all technical, clinical and managerial staff responsible for facility component freestanding ASC coding and billing. The contents include: exercises based on actual outpatient operative reports; and CPT coding guidelines for topics such as: cataracts. intraocular lens, keratoplasty, trabeculectomy, strabismus surgery, punctum plugs, tarsorrhaphy, trichiasis correction, retinal detachment repair, blepharoplasty, eyelid reconstruction, vitrectomy. 1 or more training days.
ASC Clinic: Gastroenterology Procedures- This resource is designed for all technical, clinical and managerial staff responsible for facility component freestanding ASC coding and billing. The contents include: exercises based on actual outpatient operative reports; and CPT coding guidelines for topics such as: hernia repair, nasogastric intubation, percutaneous gastrostomy tube, hemorrhoidectomy, abscess/cyst drainage, dental procedures, covered and noncovered colorectal cancer screening, gastrointestinal endoscopy, esophageal dilation. 1 or more training days.
ASC Clinic: Orthopaedic Surgery - This resource is designed for all technical, clinical and managerial staff responsible for facility component freestanding ASC coding and billing. The contents include: exercises based on actual outpatient operative reports; and CPT coding guidelines for topics such as: ganglion cyst, joint injections, decompression fasciotomy, treatment of fractures/dislocations, skeletal anatomy of the hand and foot, shoulder surgery, surgical knee arthroscopy, bunionectomy, toe-to-hand transfer with microvascular anastomosis. 2 or more training days.
ASC Clinic: Urology Procedures - This resource is designed for all technical, clinical and managerial staff responsible for facility component freestanding ASC coding and billing. The contents include: exercises based on actual outpatient operative reports; and CPT coding guidelines for topics such as: retrograde pyelogram, ureter vs. urethra, urethral dilation, ureteral stent, urethral stent, Burch Procedure, vesicourethropexy/urethropexy, urodynamics, chemotherapy. 1 or more training days.
Advanced CPT Coding: Advancement Flaps and Adjacent Tissue Transfer
(1 training day)
A. Advancement Flaps
B. Rotation Flaps
C. Z-plasties
D. V-Y plasties
E. W-plasty
F. CASE STUDIES
Advanced CPT Coding: Arthroscopic Knee Surgery
(1 training day)
A. Meniscectomy
B. Abrasion Arthroplasty
C. Synovectomy
D. Chondroplasty
E. Microfracture
F. Removal of Loose and Foreign Bodies
G. Drilling for Osteochondritis Dessicans Lesion
H. Cruciate Ligament Surgery
I. Grafting of Osteochondral Defects
J. CASE STUDIES
Advanced CPT Coding: Arteriovenous Fistulas
(1 training day)
A. Creation of AV Fistulas
B. Open Thrombectomies
C. Percutaneous Thrombectomies
D. AV Graft Revisions
E. CASE STUDIES
Advanced CPT Coding: Blepharoplasty/Eyelid Reconstruction
(1 training day)
A. Upper Eyelid Blepharoplasty
B. Lower Eyelid Blepharoplasty
C. Repair of Blepharoptosis
D. Repair of Entropion
E. Repair of Ectropion
F. CASE STUDIES
Advanced CPT Coding: Breast Surgery
(1 training day)
A. Biopsies
B. Lesion Excisions
C. Mastectomies
D. Reduction Mammaplasty
E. Breast Reconstruction
F. CASE STUDIES
Advanced CPT Coding: Bunionectomy
(1 training day)
A. Skeletal Anatomy of the Foot
B. CPT Bunion Codes 28110, 28290 - 28299
C. CASE STUDIES
Advanced CPT Clinic: Cataract, Vitrectomy and Retinal Detachment Surgery
(1 training day)
A. Simple and Complex Cataract Extraction
B. Intraocular Lens Procedures
C. Retinal Detachment Repair Techniques
D. Vitrectomy Techniques
E. CASE STUDIES
Advanced CPT Coding: Functional Endoscopic Sinus Surgery (FESS)
(1 training day)
A. Nasal Hemorrhage
B. Coding Resource: Excision of Turbinates
C. Coding Resource: FESS Codes
D. Critical FESS Documentation
E. FESS CPT Coding Crosswalk
F. Nasal/Sinus Endoscopy Report
G. CASE STUDIES
Advanced CPT Coding: Hand Surgery
(1 training day)
A. Hand Tendon Anatomy
B. Hand Joint Anatomy
C. Arthroplasties
D. Tendon Transfers
E. CASE STUDIES
Advanced CPT Clinic:
Modifier -59 Reporting and Compliance
A. Medicare Guidelines
B. CPT Coding Guidelines
C. Bundling Edit Issues
D. Compliance Alerts
Advanced CPT Clinic: Pain Management – Nerve Injections and Destruction
(1 training day)
A. Definitions
B. General Guidelines
C. Injection for Discography
D. Epidural/Subarachnoid Injections
E. Catheter Placement
F. Paravertebral Facet Joint Injection
G. Transforaminal Epidural Injection
H. Nerve Destruction
I. Percutaneous Intradiscal Annuloplasty/IDET
J. Postoperative Pain Management
K. CASE STUDIES
Advanced CPT Clinic: Pain Management – Neurostimulators and Pumps
(1 training day)
A. Neurostimulators
B. Intraspinal Catheters/Pumps/Reservoirs
C. CASE STUDIES
Advanced CPT Clinic: Female Pelvic Defect Surgery
(1 training day)
A. Anatomy of the Female Pelvis
B. Diagrams of Female Disorders: Rectocele, Cystocele, Urethrocele, Enterocele,
Stress Incontinence
C. CPT Coding Guidelines
D. Case Studies
Advanced CPT Coding: Podiatry Surgery
(1 training day)
A. Hammertoe Repair
B. Contracture Release
C. Arthroplasties
D. Amputations
E. Arthrodesis
F. CASE STUDIES
Advanced CPT Coding: Shoulder Surgery
(1 training day)
A. Bankhart Repair
B. SLAP Lesion Repair
C. Rotator Cuff Repair
D. Arthroscopic Shoulder Surgery
E. CASE STUDIES
Advanced CPT Coding: Skin Grafts
(1 training day)
A. Split-Thickness Skin Grafts
B. Full-Thickness Skin Grafts
C. Neodermis
D. Xenograft
E. Surgical Preparation for Grafting
F. CASE STUDIES
1921 Taylor Avenue
Fort Washington, MD 20744
(V) 301-292-8027
(FAX) 301-292-8244
E-mail: LolitaMJ@aol.com |
