Outpatient Surgery Magazine

Heavy Duty - October 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 46 of 126

medical necessity. This last point is especially important, since various payers may dif- fer in their understanding of the necessity of the service. Every claim should have information in it that appropriately states the medical necessity of the service. This is one area where a lot of providers make mistakes, so make sure your auditor is looking at this closely. Record and understand your audit's results If your auditor finds errors on your end, make sure she records the problems so you can implement solutions to prevent similar issues in the future. If the payer inaccurately processed claims, for example, the auditor should set those aside and contact the payer to discuss the issue. Your auditor should document the audit's results via reports, graphs, spreadsheets and charts, which will better help you identify any recurring problems or trends. These reports should include the date when the auditor spotted any discrepancies in claims, and whether these were rebilled or refunded, if appropriate. Refining your revenue cycle Although the process can be taxing, regular audits improve cash flow. They show you where there is leakage in revenue and help identify ways to curb it, whether the issue is a lack of efficient documentation, coding errors, problems in your billing department or issues with a payer's reimbursements. Once you finish the audit and identify the errors, make sure that you implement solutions and regularly check up on these coding or billing trends to continue to improve your rev- enue cycle. OSM Ms. Gupta (prerna@meddatacarepro.com) is the director of strategies for medicalbillersandcoders.com and of Med Datacare Pro, a revenue cycle man- agement company. 6 O C T O B E R 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 4 7

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