picture of your A/R.
Waiving co-pays and deductibles. While there are instances of
financial hardship, it's not acceptable for an ASC to routinely
waive co-pays and deductibles at the request of the surgeon. This
practice may violate the Anti-Kickback Statute, which applies to all
sources of referrals, including patients. In short, adhere to the con-
tracts you have entered into with the payer by collecting applicable
co-pays and deductibles.
Failing to report claims-based quality measures. Under the
Ambulatory Surgical Center Quality Reporting Program, ASCs must
report quality of care data on their submitted claims for 5 standardized
measures to receive the full annual update to their ASC annual payment
rate. The top 5 measures are patient burn; patient fall; wrong site, wrong
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Coding & Billing
CB
2 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 7
OUTSOURCING
Demand Transparency From Your Outside Billing Company
Your surgery center is accountable not only for its actions, but
also for the actions of business partners who provide services on
your behalf. In cases involving allegations of fraud or abuse, your
insurance carrier contract may require expedient accessibility of
records as soon as 48 hours after it asks to review billing prac-
tices and claims payment. Ensure any extension of your on-site
business office has an open-door policy of its policies, procedures
and practices, and require full transparency of processes to
include access to your facility accounts to fulfill your monthly
auditing and monitoring requirements. If transparency cannot be
achieved to your satisfaction, seek other partnership options.
— Cristina Bentin, CMA, CCS-P, COC, CPPM
