Updated: Jul 17
This Helpful Advice Will Prevent Denials as a Result of 2021 Surgery Center Coding Changes
The healthcare industry is constantly evolving, and one area that sees regular updates is medical coding and billing. Surgery centers, in particular, must stay vigilant in keeping up with coding changes to avoid denials and ensure smooth reimbursement processes. The year 2021 brought about significant coding changes that impacted surgery centers' billing practices. In this article, we provide essential advice to prevent denials as a result of the 2021 Surgery Center coding changes, helping these facilities maintain financial stability and provide quality patient care.
1. Stay Informed About Coding Updates
The first and most crucial step to prevent denials is to stay informed about coding updates and changes. The American Medical Association (AMA) releases annual updates to Current Procedural Terminology (CPT) codes, and the Centers for Medicare & Medicaid Services (CMS) issue updates to the Healthcare Common Procedure Coding System (HCPCS) codes. Regularly check official websites and industry publications to be aware of any new, deleted, or revised codes that might impact your surgery center's billing practices.
2. Conduct Comprehensive Staff Training
Coding changes can be complex, and mistakes can lead to claim denials or payment delays. Conduct comprehensive training sessions for coding and billing staff to ensure they are well-versed in the new codes and understand how to accurately apply them. Invest in continuing education programs to keep your staff up-to-date with the latest coding guidelines and best practices.
3. Perform Regular Audits
Performing regular internal audits is an effective way to identify potential coding errors and billing discrepancies before they result in denials. These audits should focus on coding accuracy, documentation completeness, and compliance with coding guidelines. Address any issues promptly and implement corrective measures to prevent future problems.
4. Enhance Documentation Practices
Accurate and detailed documentation is essential for proper coding and billing. Encourage your healthcare providers to be thorough and specific in their documentation to support the codes selected for each procedure. Clear documentation ensures that medical coders can assign the appropriate codes, reducing the risk of denials due to insufficient or vague information.
5. Utilize Technology Solutions
Embrace technology solutions that can streamline the coding and billing processes. Electronic Health Record (EHR) systems and medical billing software can automate coding, flag potential errors, and provide real-time updates on coding changes. These tools not only increase efficiency but also reduce the likelihood of denials caused by human errors.
6. Verify Insurance Coverage in Advance
To prevent denials related to insurance coverage, verify each patient's insurance eligibility and benefits well in advance of their scheduled procedure. Understand the specific requirements of different insurance plans, such as prior authorizations or pre-certifications, to avoid unnecessary denials.
7. Monitor Claim Submission and Rejections
Monitor the status of claim submissions closely and track any rejections or denials promptly. Timely follow-up on denied claims is essential to identify the reasons for denials and rectify the issues. Create a structured process to address denied claims, resubmit them with appropriate corrections, and appeal if necessary.
8. Establish Clear Communication Channels
Effective communication within your surgery center is essential to address coding changes and denials efficiently. Encourage open communication between healthcare providers, coders, billers, and administrative staff. Regular team meetings and updates can facilitate the flow of information and help avoid potential issues related to coding changes.
Preventing denials resulting from 2021 Surgery Center coding changes requires proactive measures and continuous vigilance. Staying informed about coding updates, comprehensive staff training, regular audits, enhanced documentation practices, technology utilization, insurance verification, claim monitoring, and clear communication are key elements to ensure a smooth billing process and financial stability for surgery centers. By implementing these pieces of advice, surgery centers can mitigate the risk of denials, enhance revenue cycle management, and provide seamless patient care in this dynamic healthcare landscape.