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Archive April 2017 XVIII, No. 4

Coding & Billing: 3 Places to Look for Hidden Revenue

You're likely to find income stashed away in these unexpected places.

Rebecca Geise

Rebecca Geise



Chances are you're missing out on at least a few opportunities to increase cash flow — all because you're not looking in these 3 unlikely places.

1Ancillary procedures. These are the additional sources of revenue for services provided outside of standard OR charges or procedure revenue: imaging, lab and neuro-monitoring. Good documentation is the first step to capturing this revenue. This depends on a clear communication loop among the OR, materials management and the business office (see "Growing Revenue Is a Team Sport").

For some revenue sources, specifically those for contracted services such as neuro-monitoring, study your agreement with the service provider to determine whether your facility or the service provider will bill for the service. In addition, know whether you're billing for the technical component (TC modifier) or the professional and technical component (no modifier). Clearly outline documentation of the services in the patient chart, and establish a system for communicating this to billing.

Physician documentation of a C-arm, ultrasound or other imaging used during a case is critical. These services are typically billed for technical component only (TC modifier). Understanding payer guidelines and payer contract coverage is critical in knowing when you'll be reimbursed for these services.

2Implants and supplies. Implants, high-cost supplies and medications used during a case are valuable sources of revenue for your facility. They can be a determining factor in the overall profitability of your cases and, really, the financial success of your center. For implants and high-cost supplies, have a policy that establishes thresholds for what's considered billable. An example: All implants, regardless of cost, are captured on each case and communicated to billing, while high-cost disposable supplies (drill bits, ablators, suture passers and blades, for example) must meet an individual cost of $200 each unit to be captured for billing; anything less than $200 per unit would be absorbed in the case cost and standard fees for the case.

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