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What's the Harm? - December 2015 - Outpatient Surgery Magazine

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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2 3 D E C E M B E R 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T size is about 10% of your case volume) and look for any errors, incon- sistencies or trends. How often you hold these reviews — bi-weekly, monthly, quarterly, yearly — depends on your facility's volume and if you know of any existing problems. Most of the time, inaccurate coding stems from redundant codes, tem- porary codes, revenue codes (in hospitals), DRG code complexity and the usage of varied software or systems. Look closely for problems in these areas. Once you identify any inaccuracies, you can work with your coders to correct future claims. AR follow-ups A lack of timely accounts receivable (AR) follow-ups was the sec- ond most common problem our respondents faced. Most said that it was hard for their billing department to get insurers to pay up within 21 days of claims filing, leading to AR accumulation. A simple but effective way to improve your AR is to designate a team of staffers to follow up on unpaid claims. Have this team pri- oritize accounts by starting with your highest-dollar-value AR from your oldest cases and working down the list. Set clear expectations for when you want these claims cleared out of the system and track your team's progress. Be sure to set time frames that specify when these unpaid claims should be followed up on, how often and when you expect payment. For example, your team's goal may be to follow up with the insurer every 15 days after a claim's submission, with the goal of getting it paid within 40 days. While delaying or forgetting to check on an unpaid claim here and there might not seem like a big deal, a continu- ous lack of AR follow-up can lead to huge write-offs down the road. In fact, we found that if the AR days are between 180 and 360 days, the chances of collection are below 10%. 2

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