Obtaining the full reimbursement you deserve while remaining compliant with federal, state and managed care regulations is imperative to keeping your doors open and achieving year-over-year growth. Several areas in your revenue cycle that affect compensation also are potential areas for noncompliance.
Compliance in Providers’ Reports
The first step in the post-procedure revenue cycle is the providers’ procedure reports. Accuracy, detail and timeliness all are essential if your ASC is going to optimize the coding of the procedures performed. Without these reports and those elements, the only option for obtaining reimbursement is “assumption” coding or the coding of a diagnosis or procedure without supporting clinical documentation. This practice, however, does not adhere to federal and state regulations. Therefore, it is important that all necessary documentation (e.g., operative report, pathology report, applicable invoices for implants and/or supplies) be available to the coder in a timely manner.