Becker's ASC Review

38 Coding & Billing T he beginning of a new year in the ambula- tory surgery center industry is rapidly ap- proaching. Along with a new year, comes a series of changes impacting ASC workflow and reimbursement. Three industry experts outline six of the biggest coding and billing changes to anticipate for 2015. 1. ICD-10. When signed into law in April, the Pro- tecting Access to Medicare Act of 2014 effectively delayed ICD-10 implementation until Oct. 1, 2015. Though the switch to the new code set will take place 10 months into the year, the ramifications make it one of the biggest changes to anticipate — the shift from approximately 14,000 ICD-9-CM codes to 68,000 ICD-10-CM codes is no small step to take. "It could take [ASCs] six months to a year to get up to speed," says Michael Orseno, revenue cycle director with Regent Surgical Health. In addition to preparing all software and staff in- ternally, ASCs will need to form closer ties with physician office coding staff. "We will see an in- creasing collaboration between provider facilities and physician offices," says Mr. Orseno. "Submit- ting a claim with different codes from the physi- cian's office and the ASC may delay payment." "The overall impact of ICD-10 on revenue is still not known, other than there will be the usual sort of factors that cause cash to decrease in the short term, i.e., errors in implementing systems, learn- ing curve for coders, payers' internal systems not working as expected, etc.," says Francisco Silva, operations manager with abeo. 2. CPT code updates. The American Medi- cal Association is set to release 2015 updates for its Current Procedural Terminology code set on Nov. 1. Last year, upper GI/endoscopy codes were reviewed and nearly 25 percent of the CPT code changes affected the field of gastroenterol- ogy. This year, lower GI codes, including those for colonoscopy, are up for review. Radiology and pain management will also be affected by the CPT code changes, says Ladonna Schaad, coding com- pliance manager with abeo. 3. Modifier -59 change. CMS is creating four new HCPCS modifiers to define subsets of modi- fier -59, which denotes a "distinct procedural ser- vice." The four new HCPCS included: • XE Separate Encounter • XS Separate Structure • XP Separate Practitioner • XU Unusual Non-Overlapping Service "We can still use modifier -59, but CMS has the right to insist there is a more specific modifier needed," says Ms. Schaad. "Column 1 and column 2 CPT codes will the most impacted." 4. Bundled codes. ASC leaders can expect to see the bundling of multi-level pain procedures in 2015. "CMS is no longer allowing more than one level of pain procedure. They are not paying on more than one code," says Mr. Orseno. "We can expect to see other major payers follow this lead." The bundling of codes will lead to a decrease in reimbursement for a number of pain procedures performed in ASCs. Radiology is also being impacted by bundled codes. "We are seeing ever increasing bundling with radiology and ultrasound codes," says Ms. Schaad. "Three new joint arthrocentesis codes for 2015 will include ultrasonic guidance, which will impact reimbursement." 5. Increase in MNRPs. Mr. Silva forecasts that more payers will begin to increasingly offer Maxi- mum Non-Network Reimbursement Plans, or Medicare-based plans, which have lower rates of reimbursement. "With the increasing volume of MNRPs, payers are opting to reimburse at the lower Medicare rate than historic reimbursement rates, i.e., PPO or commercial-based plans," says Mr. Silva. "An analysis should be done comparing the CYTD and PYTD payer and case mixes and based on the results of that analysis, the ASC directors need to be educated on how the cash flow will be impacted." 6. Payer demand for specificity. Payers will not only expect providers to adhere to the increased specificity of ICD-10, but many are also calling for complete medical records prior to claim adjudication. Failure to supply com- plete medical records for these payers can lead to claim denial and loss of appeal rights. Perform an analysis of payer mix to determine which payers are calling for information. "The revenue cycle management office could then be proactive by dropping the claims to paper for those particu- lar payers/procedures and including the complete medical records on the first submission," says Mr. Silva. "The ASC's RCM office needs to respond to the issue quickly and efficiently." n 6 ASC Coding & Billing Changes to Anticipate in 2015 By Carrie Pallardy brochures and counter displays. Practices should take advantage of these materi- als and display them in your waiting area and exam rooms. You can also highlight the benefits of financing in your new patient materi- als, on your website and as part of your marketing and advertising activities. When patients know that special financing options*are available, they may be more likely to seek care at your practice than at another that does not. In fact, in a recent survey of orthopedic practices currently accepting CareC- redit, over 20 percent said using CareCredit has played a role in increasing the number of patients seen in the practice. 1 Q: What else did you find out from the orthopedic practice survey? RM: Well, the most significant benefits stated by orthopedic practices offer- ing CareCredit were that practices that accept the healthcare credit card said that it helped improve cash flow, eliminate billing and the difficulty related to collecting delinquent accounts. But the one survey finding I found to be the most impressive was that 98 percent of orthopedic practices would recom- mend CareCredit to a colleague. 1 I think these practices know first hand that adding a patient financing pro- gram gives patients a payment solution that fits their budget and lifestyle, and can help them move forward with the treatment they need. At the same time accepting patient financing helps increase treatment acceptance, reduce A/R and improve cash flow — all benefits that can help your practice stay healthy too. n *Subject to credit approval. Minimum monthly payments required. See carecredit.com for details. 1. 2014 Orthopedic Practice Usage Drivers, a study conducted for Care- Credit by Inquire Market Research. Michael Orseno 54

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