Here are five tips for smart orthopedic surgery center administrators.
1. Create an environment of trust, cooperation and communication. It shouldn't feel like pulling teeth when management requests reports and other information needed to evaluate performance, nor should it feel that way when the payroll function needs the hours for the pay period in order to prepare the payroll, says Edward J. Gorza, CPA, accounting manager for MedHQ. Everyone has a job to do and each side will need to keep up its end of the bargain. Procedures and tools should be developed to make information exchanges simple and pain free. Outsourcing companies like MedHQ offer such "coupling" tools as accessible personnel, accounting software, payroll and HR software, regular reporting and customizable reporting.
2. Hire business professionals for back office work. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving surgery center. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
3. Be prepared for denied claims. Practice coders should also know how to handle denied claims. Claims are denied for a multitude of reasons, and coders may need to refer back to physicians to get updated information. If a procedure is done differently than usual, the coder must know the reasoning behind this change to receive reimbursement from the insurance company. "If the surgery is done in a different anatomical position for one reason or another, there are different units for pain management reimbursement," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions "Make sure the coders know what you are doing because correct clinical documentation can speed up the payment process."
An ongoing dialogue between coders and pain management physicians is essential for an effective billing process. "The physician shouldn't be surprised when they get questions from the coders," says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. "Have a process in place for communication because billing and coding is complicated. There needs to be a dialogue in place for an effective billing process."
4. Start looking at ICD-10 equivalency mapping. While the 2013 implementation date for ICD-10 is still a couple of years away, Raemerie Jimenez, director of education for AAPC, says coders should start looking at the expectations involved in ICD-10 coding and documentation. "It would be good for coders to see the ICD-9 codes that they're typically coding now and see what the ICD-10 equivalents are going to be," she says.
Rosalind Richmond, CCS, interim coding compliance officer for Genascis, says while coders should not depend on general equivalency mappings to code ICD-10 going forward, GEMs will be useful as coders prepare for training in 2012 and 2013. She says the huge increase in the number of codes through ICD-10 means that GEMs are complicated. "Trying to [explain ICD-10 with ICD-9 codes] is like trying to fit New York into Rhode Island," she says.
5. Stay on top of infection control protocol. It's important to stay on top of infection control, and paying attention the the disinfectant's label is an important part of that. The label should tell you if a product is compatible or not compatible with particular surfaces, says Jack Wagner, president of Micoro-Scientific. As an example, there a chemical surface wipe that says in the small print on the bottom of the label, "Do not use this product on clear plastics." This tells me that it is not appropriate for clear plastics, which include domes (the covering on anesthesia machine ventilators), plastic lenses over operating lights and blood pressure cuffs. There are a number of materials in an ambulatory surgery center that are made of clear plastics. If this product cannot be used on clear plastics, then obviously this product is not compatible with an ASC's equipment and is not appropriate for use in a center, he says.
Related Articles on Orthopedic ASCs:
100 Orthopedic- and Spine-Driven ASCs to Know
8 Things to Know About ASC Ownership and Development
10 Benchmarks on Orthopedics-Driven ASCs
2. Hire business professionals for back office work. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving surgery center. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
3. Be prepared for denied claims. Practice coders should also know how to handle denied claims. Claims are denied for a multitude of reasons, and coders may need to refer back to physicians to get updated information. If a procedure is done differently than usual, the coder must know the reasoning behind this change to receive reimbursement from the insurance company. "If the surgery is done in a different anatomical position for one reason or another, there are different units for pain management reimbursement," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions "Make sure the coders know what you are doing because correct clinical documentation can speed up the payment process."
An ongoing dialogue between coders and pain management physicians is essential for an effective billing process. "The physician shouldn't be surprised when they get questions from the coders," says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. "Have a process in place for communication because billing and coding is complicated. There needs to be a dialogue in place for an effective billing process."
4. Start looking at ICD-10 equivalency mapping. While the 2013 implementation date for ICD-10 is still a couple of years away, Raemerie Jimenez, director of education for AAPC, says coders should start looking at the expectations involved in ICD-10 coding and documentation. "It would be good for coders to see the ICD-9 codes that they're typically coding now and see what the ICD-10 equivalents are going to be," she says.
Rosalind Richmond, CCS, interim coding compliance officer for Genascis, says while coders should not depend on general equivalency mappings to code ICD-10 going forward, GEMs will be useful as coders prepare for training in 2012 and 2013. She says the huge increase in the number of codes through ICD-10 means that GEMs are complicated. "Trying to [explain ICD-10 with ICD-9 codes] is like trying to fit New York into Rhode Island," she says.
5. Stay on top of infection control protocol. It's important to stay on top of infection control, and paying attention the the disinfectant's label is an important part of that. The label should tell you if a product is compatible or not compatible with particular surfaces, says Jack Wagner, president of Micoro-Scientific. As an example, there a chemical surface wipe that says in the small print on the bottom of the label, "Do not use this product on clear plastics." This tells me that it is not appropriate for clear plastics, which include domes (the covering on anesthesia machine ventilators), plastic lenses over operating lights and blood pressure cuffs. There are a number of materials in an ambulatory surgery center that are made of clear plastics. If this product cannot be used on clear plastics, then obviously this product is not compatible with an ASC's equipment and is not appropriate for use in a center, he says.
It's also important to note that some disinfectants are approved as cleaners and disinfectants. Some are simply disinfectants, which would mean you would need to clean the surface with soap and water, rinsing and drying it before you apply the disinfectant. All of these details are listed on the label.
Related Articles on Orthopedic ASCs:
100 Orthopedic- and Spine-Driven ASCs to Know
8 Things to Know About ASC Ownership and Development
10 Benchmarks on Orthopedics-Driven ASCs