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CODING & BILLING
managed care contract updates, payor challenges, coding and billing
issues, collection goals and denial trends. Understanding your business staff's work goes a long way toward improving its results.
Physician outreach
o Physicians do cases where it's easy to schedule them, so develop a
user-friendly process. Many facilities have implemented hard copy or
electronic scheduling request forms, rather than requiring phone calls
to make arrangements.
o Deficient documentation adversely affects your reimbursement.
Address coding and billing concerns and their financial impact at your
medical executive committee meetings. Your business staff can tell
you which of your surgeons provide ambiguous op notes.
o Keep your surgeons updated when Medicare approves new procedures for reimbursement, so they can bring them to your ORs. Make
sure they're also aware which procedures offer little or no reimbursement to your facility.
Patient management
o Don't depend on the physician's staff to verify a patient's insurance
coverage or pre-certification of a procedure. Verify it in-house.
o Make a policy of re-verifying a patient's insurance coverage when
there's a significant lapse between the initial verification or pre-certification and the scheduled date of surgery. A patient who's ruled eligible for a procedure in June might not be covered for one in July.
Deductibles met in December will be fully collectible in January.
o Notify patients of their estimated financial responsibility in
advance, and ask for payment on, if not before, the date of service
(see "Collect Every Dime Your Patients Owe" on page 16). While
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