With the new CMS rules, many finance heads are focusing on the inpatient side. But they should be careful not to dismiss ambulatory payment issues, says D. Wayne Little, CPA, director of ambulatory care services at 3M Consulting Services in Atlanta.
“Under ambulatory payment classifications (APCs), complete and accurate diagnosis coding is necessary to support medical necessity – and accordingly, a key to whether a claim gets processed for appropriate payment,” Little says. “However, there is an additional focus on capturing accurate and complete procedure codes to recover appropriate reimbursement for all procedures performed.”
On the outpatient side, Little offers these suggestions for cost savings and process improvements:
- See where you stand. Develop a performance dashboard based on claims data.
- Form operational teams to brainstorm solutions. For example, a focused denial management team—with members from chargemaster, HIM, billing, and patient financial services—can determine how to fix problems earlier in the revenue cycle.
- Reprioritize Every year, the coding rules change. Re-evaluate priorities based on new codes and in-house changes, such as the addition of new services.