10 Revenue-Cycle Mistakes to Avoid
These blunders could endanger more than just your reimbursements.
R
eimbursements are the lifeblood of your surgical facility,
which is why you fight so hard for every dollar. At the same
time, you need to evaluate your entire revenue cycle so your
processes are efficient, accurate and profitable. Avoid these 10 com-
mon mistakes that could put your reimbursements — and your facili-
ty — at risk.
Submitting fraudulent claims. Under the False Claims Act, it is
illegal to submit claims for payment that you know or should
know are fraudulent. When you bill a claim, your facility is certifying
that it has earned the payment requested and complied with the
billing requirements.
Always let the physician's written clinical
documentation determine your code selection. Your center is
subject to a take-back of all overpayments when discov-
ered, and it might also incur additional monetary penal-
ties per violation above and beyond the overpayment.
If
you bill it, federal investigators will take notice.
Reporting the wrong place-of-service code.
Although no one should ever misrepresent place of
service, there's an uptick in the reporting of the place of
service "11: physician office" by the physician office staff
for procedures performed in the ASC simply to get claims
out the door. The correct place-of-service code reported by
the physician office when a procedure is performed in an
ASC should be "24: ambulatory surgery center."
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2 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T
Coding & Billing
Cristina Bentin, CMA, CCS-P, COC, CPPM
