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No More Empty Beds - Outpatient Surgery Magazine - February 2020

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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How much higher? Keeping in the mind that rates for commer- cial payers vary, the Medicare Adjusted Reimbursement Rate for CPT 29827 is $2,744.32 and $1,256.79 for CPT 29822. If you code according to the NCCI edit guidelines, you'll receive $2,744 for the bundled pro- cedures, about $1,250 less than you'd make by billing them under AMA guidance. Granted, the majority of payers are starting to follow NCCI edit guidelines — and that's only likely to increase moving forward. But there are still quite a few payers that follow AMA guidelines, and I've seen a lot of facilities lose out on reimbursements by not being aware of this. Don't miss out; check your payer contracts. Quarterly audits a must In addition to knowing the ins and outs of your payer contracts, you'll also need to schedule external audits of your coding and billing practices on a quarterly basis. Yes, a lot of facilities do annual audits, but here's a major reason why that time frame isn't ideal: What if the audit uncovers claims that need to be rebilled? If you're doing the audit yearly, you could easily fall outside of the payer's statute of limitations for resubmitting claims. Most times, a Coding & Billing CB 2 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 0 An audit is all about taking corrective action on your policies, not your people.

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