46
CODING
&
BILLING
ASC revenue
cycle, revisited
– best ideas
for meeting
benchmarks from
3 administrators
By Laura Dyrda
R
evenue cycle management is a crucial
aspect of running a successful ASC.
Here, three administrators discuss
their best practices for meeting revenue cycle
benchmarks.
Kathryn Rice. Administrator of Bayfront
Health Ambulatory Surgery Center (St.
Petersburg, Fla.): I have found that simple
things such as demographic errors and missing
information can hold up your billing cycle and
hinder you from meeting benchmarks. You
have to have an attitude of urgency and nothing
le unturned to move you forward. Continu-
ous communication with your billing team is
extremely important as well as making sure you
have an updated charge master. In addition,
your money is in your contracts. If you aren't
checking your contracts carefully, you can
have missed opportunity. Contracts should be
reviewed at a minimum of every three years.
Raghu Reddy. Executive Administrator of Surg-
Center of Western Maryland (Cumberland,
Md.): We ensure that dictations are complete
within 24 hours of case date and the coding
and billing within 48 to 72 hours. We address
all claim denials and rejections promptly
and aggressively follow up with the payers to
ensure we meet the goals of our collections. We
partner with our billing team to ensure all the
internal benchmarks and audits are reviewed,
and the feedback is implemented right away.
We have a seamless communication process
with the billing team to ensure our revenue cy-
cle management stays smooth. We also monitor
our contracts and ensure that payer is following
the negotiated fee schedules and timelines.
Bonnie Goodwin. Administrator of Tallahassee
(Fla.) Outpatient Surgery Center: To meet our
revenue cycle benchmarks, we have recently
engaged our centralized billing office who have
been meeting those benchmarks of days in ac-
counts receivable, collection percentages, etc.
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Minnesota Hospital Association
challenges Blue Cross policy shifting
services to ASCs
By Rachel Popa
T
he Minnesota Hospital Association is accusing Blue Cross Blue
Shield of Minnesota of breaking the law through policies that limit
access to colonoscopies and other services in hospitals in favor of
having them in lower-cost settings, like ASCs, according to a letter from
the association cited by the Minneapolis StarTribune.
Three details:
1. Through its policies, Blue Cross Blue Shield of Minnesota won't cover
such services as endoscopies and colonoscopes in-network at a hospital
if an ASC or outpatient clinic within 25 miles offers the same services but
at a lower cost. The insurer argued that the policies are identical to those
imposed by Medicare for its beneficiaries, and that it is its job to steer
patients to lower-cost settings in light of rising healthcare costs. Blue Cross
Blue Shield also said that hospitals can meet outpatient clinic pricing to
allow patients to have the procedure in the hospital.
2. The hospital association said that the restrictions, which also require
patients to get prior authorization for more than 250 services, will limit
patients' access to medically necessary treatments and diagnostic services
and make the process of getting care more expensive. The association
said Minnesota law don't allow Blue Cross Blue Shield to discriminate
against in-network hospital providers, and that the new policies may break
unfair and deceptive trade practice laws.
3. Minnesota Attorney General Keith Ellison said his office will "dig into"
the association's concerns.
n
Delaware pain physician indicted in
$12.7M Medicare fraud scheme: 4 details
By Laura Dyrda
T
he Department of Justice unsealed an indictment against a Wilm-
ington, Del.-based pain physician for allegedly participating in a
scheme to defraud Medicare of millions of dollars.
Four things to know:
1. Frederick Gooding, MD, president and CEO of Gooding Medical Corp.,
based in Wilmington, was charged with 11 counts of healthcare fraud and
arrested on Aug. 1.
2. Dr. Gooding is charged with billing Medicare for medically unneces-
sary procedures including injections and aspirations. In some cases, the
procedures were not provided, and Dr. Gooding is accused of falsifying
medical documents to make it appear that he delivered medically neces-
sary services to Medicare beneficiaries, when that was not the case.
3. From January 2015 to August 2018, Dr. Gooding is accused of submit-
ting fraudulent claims that resulted in $12.7 million in payment.
4. Dr. Gooding appeared in court on Aug. 2, but a trial date has not been set.
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