Becker's ASC Review

40 Coding & Billing productive way to walk through common coding, billing and documentation issues with physicians. These settings also provide an opportunity to generate valuable feedback from physicians be- cause, after all, coders are not in the room when the procedures are performed. Many ASCs hold scheduled monthly meetings with physicians and the billing department to discuss issues that have arisen in the previous weeks. In these meetings, billing staff can discuss specific cases where notes were not specific enough, or provide examples of cases that included insufficient docu- mentation. Coders should continue to educate themselves on the structure and function of the human body. With a greater understanding of anatomy, coders and physicians can speak a common language that enhances communication and improves under- standing of the procedures performed, leading to greater accuracy in coding. Coding rules also are continually changing, so it's very important that coders stay current on the latest updates, rules and guidelines – and educate physicians accordingly. Electronic health records systems are here to stay. Mandated by federal law, these virtual platforms were designed to replace the cavernous, back- office filing rooms that once were a mainstay in healthcare facilities. Intended to create efficiencies and allow physicians and specialists to collaborate on patient care, EHR systems often require substantial user training for physicians and staff, especially in pain manage- ment. For example, the complexities of pain man- agement makes it difficult to design convenient drop-down menus on an EHR system's user inter- face. That means physicians often need additional training on how pain management procedures should be articulated in the on-screen text boxes. Like all businesses, money talks in healthcare. Many ASCs are joint ventures among physicians, hospitals and/or outside investors. If bills do not accurately represent the procedures that were per- formed at the facility, the ASC and each physician likely will suffer financially because of it. This issue is particularly acute in pain manage- ment, a specialty in which coding can seem more like an art than science. Reminding physicians that insufficient or incomplete documentation can directly result in under billing or over bill- ing often underscores to them what's at stake, i.e. their personal financial livelihood. Chronic pain management is expected to be a growing area of specialty medicine in the coming decades. According to the Pew Research Center, between now and 2029, an estimated 10,000 baby boomers per day will reach retirement age – and with it, the aches and pains of the aging process. By creating a thorough narrative of each patient's treatments, collaborating together and implement- ing technology, ASCs can lead the way in improv- ing patient satisfaction, treatment options and financial models in chronic pain management. n DISC Sports & Spine Center Signs In-Network Agreement With Anthem Blue Cross: 5 Things to Know By Carrie Pallardy D ISC Sports & Spine Center in Marina del Rey, Calif., has signed an in-network agreement with Anthem Blue Cross. Here are five things to know about the new agreement and the spine center. 1. DISC signed an in-network network agreement with Anthem Blue Cross, the largest commercial payer in California, which will include both of its ambulatory surgery centers: Diagnostic and Interventional Surgical Center and DISC Surgery Center at Newport Beach. 2. The new agreement is effective immediately. "We are very pleased at the opportunity to work with Anthem Blue Cross in breaking some ex- citing new ground for patients," said DISC COO Karen Reiter. "Such an in-network relationship gives subscribers affordable access to superior healthcare while reducing the overall impact on an already taxed health system in America." 3. DISC struck in-network agreements with UnitedHealthcare and Aetna in 2010 and 2011, respectively. 4. DISC began negotiations with Anthem Blue Cross in 2013. The final- ization of the agreement was pushed forward with help from the center's partner Surgical Care Affiliates. 5. DISC plans to expand its full-time and per diem staff by 25 percent to 35 percent to accommodate all future patients. DISC also plans to ex- plore more in-network opportunities. n ASC-Specific Bundled Payments Coming to California — 8 Key Concepts By Laura Dyrda Bundled payments may be coming to more ambulatory surgery centers in California — are you ready? Blue Shield of California partnered with Global One Ventures to launch the Bundled Fee Program for ASCs. "The single payment option motivates facil- ity and physicians to function as one team and to adopt best practices," said Global One Ventures Principal Tom Wilson. "This program was developed out of a need for transparency in pricing for routine surgeries performed at an ASC." Here are eight things to know about the program: 1. The program is designed for facility, surgeon and anesthesiologist alignment to promote higher quality care in the low cost setting. 2. Orthopedic and joint replacement surgeries are ideal for the program because they are pre-diagnosed conditions. 3. The payers will include a single payment to reduce waste and redundan- cies while aligning providers around a surgical episode of care. 4. The program is expected to become the main surgical episode pay- ment methodology for PPO members over the next five to 10 years. 5. There would be one price and bill to the patient, and costs would be transparent as well as lower than other options. 6. Surgeons are able to perform higher acuity cases in the ASC with the bundled rate, which can lower infection and complication risks. 7. Global One will handle any program appeals that BSC requires. 8. The billing is streamlined. n

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