side, wrong patient, wrong procedure, wrong implant; hospital
transfer/admission; and prophylactic IV antibiotic timing. ASCs that
don't meet program requirements may receive a 2% reduction in ASC
payment updates.
While some facilities have ensured that they report these 5 claims-
based measures by setting internal billing systems to auto-populate the
2 default codes to all CMS claims, there is no oversight to ensure accu-
racy if and when an event does occur. In some cases, CMS claims are
routinely billed with the 2 default codes unless and until the billing
office is verbally instructed otherwise. On the flip side, some ASCs
aren't meeting the program minimal reporting requirements and are
now being hit with a 2% reduction in Medicare payments. The verifica-
tion of these quality measures is a clinical function, not a billing func-
tion. The last entry before discharge should be to review and verify
these measures. How do you do so? Speak to your software vendor
about adding a drop-down menu for all applicable claims-based quality
measures that must be reviewed and checked off before clinical chart-
ing is deemed complete.
Failing to self-audit. Fraudulent billing practices can go unno-
ticed if you or a central business office or billing company fail to
conduct weekly/monthly internal audits of all aspects of the revenue
cycle.
OSM
Ms. Bentin (cristina@ccmpro.com) is the president of Coding Compliance
Management in Baton Rouge, La., which helps surgery centers manage their
coding, education and audit programs.
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