Becker's ASC Review

45 eligibility. • Medical coders must understand the ins and outs of each patient's health insurance contract. Not only do they need to know the relevant codes for each surgery, but how particular im- plants and procedures are reimbursed. Every contract uses the same com- mon procedural terminology (CPT) codes but how they determine implant reimbursement will likely be different depending on the contract. Creating summaries of pertinent information from each contract can enable cod- ers to easily and quickly find needed information. • Revenue cycle staff members need to understand the documentation each payer requires for different implant charges. When the payments are received, they need to ensure that the payments match the amount stipulated in the contracts. Most importantly, they need to flag underpayments. For example, when a payment was received for $16,000 but the contract stipulated $20,000, staff members need to note this underpayment and follow up. • Staff should conduct a monthly audit to ensure that each procedure was coded, billed and paid correctly. If they uncover any discrepancies, they should drill down to see where the mistake originated, and then file an appeal if warranted. In the final analysis, the importance of paying attention to the revenue cycle details cannot be underestimated. Even a seemingly insignificant mistake could lead to denials, incorrect payments, underpayments or even no payment at all. When details have been addressed, though, your ASC stands to reap considerable financial rewards. n References 1 Vizient. Outpatient Joint Replacement: An Un- necessary Concern or Market Reality? https:// newsroom.vizientinc.com/newsletter/research-and- insights-news/outpatient-joint-replacement-unnec- essary-concern-or-market-research CMS may require hospitals to post price, payer negotiated rates online — what does it mean for ASCs? By Laura Dyrda T he CMS Medicare Outpatient Prospective Payment System 2020 proposed rule included a requirement for hospitals to publish standard prices and payer-specific negotiated rates. Hospitals would be required to publish the negotiated rates for 300 services patients are most likely to shop for; CMS defined 70 of those services. The hospitals would be responsible for publishing rates in an easily accessible way. Hospitals that fail to comply face fines totaling up to $300 per day. The American Hospital Association is not pleased with the proposal, and plans to fight back if CMS finalizes that aspect of the rule. In a joint statement with other hospital associations, the AHA stated: "Hospitals and health systems want to ensure patients have access to information they need to choose their healthcare, including out-of-pocket obligations. This rule, however, is a misguided attempt to improve price transparency for patients because it fails to give them the infor- mation they need." The statement goes on to proclaim making negotiated rates with insurance companies public wouldn't improve patient decision-making and could reduce access to care. Bloomberg Law reported insurance companies may also fight against making negotiated rates public. How would this affect ASCs? ASCA CEO William Prentice ad- dressed this in an interview posted on the ASCA website: "If approved, the requirement that hospitals post their negotiated prices will likely spur CMS to expand that requirement to other providers over time. We will be paying close attention as this proposal moves forward and will keep our members apprised of all developments." n AMA releases 394 code changes for 2020 — 3 things to know By Angie Stewart T he American Medical Association unveiled the 2020 Current Procedural Terminology code set, which includes 394 changes to CPT codes and descriptors. Three things to know: 1. The AMA made 248 additions, 71 deletions and 75 revisions to reflect ad- vancements in medical technology and health monitoring. New CPT category I codes go into effect Jan. 1, 2020. 2. With input from physicians, medi- cal specialty societies and the greater healthcare community, the CPT Editorial Panel made the following key changes: • Added six codes to document e- visits • Added two codes to report self- measured blood pressure monitor- ing • Replaced six older codes with five new codes and four add-on codes for health and behavior assess- ment and intervention services • Deleted four codes for reporting long-term electroencephalograph- ic monitoring services to make way for 23 new codes 3. The downloadable CPT 2020 Data File contains the updated code set's complete descriptor package and the official CPT coding guidelines. The file allows 2020 CPT codes and descriptors to be imported straight into existing claims and billing software. n

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