Archive August 2017 XVIII, No. 8

Coding & Billing: 10 Revenue-Cycle Mistakes to Avoid

These blunders could endanger more than just your reimbursements.

Cristina Bentin

Cristina Bentin, CCS-P, CPC-H, CMA


troublesome billing practices COLLECT WITH CARE Unbundling, which is when you report separate codes for related services when one comprehensive code includes all related services, is one of several troublesome billing practices.

Reimbursements 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 common mistakes that could put your reimbursements — and your facility — 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 discovered, and it might also incur additional monetary penalties 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."

Unbundling. Unbundling occurs when you bill multiple procedure codes for a group of procedures that are covered by a single comprehensive code. This erroneously results in higher reimbursement. Unbundling comes in many shapes and sizes, from fragmenting one service into component parts and coding each component part as if it were a separate service to breaking out bilateral procedures when one code is appropriate. Another example is separating a surgical approach from a major surgical service, as in reporting a laparoscopic hernia repair using 2 codes — one for a diagnostic laparoscopy and another for the laparoscopic hernia repair — when that approach is already included in the laparo-scopic hernia repair code.

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