Accelerating revenue cycle management is a top priority for ASCs. The success of a surgery center rests on shortening the revenue cycle by eliminating errors and minimizing the potential for claims denials. Since ASCs are already run with tight budget constraints and limited resources, any missed payments or rejections from payers can deeply impact the bottom line.
While the issue is complex, one of the biggest bottlenecks is the act of gathering the right information and submitting it to payers for reimbursement. The process is, collectively, a giant migraine for surgeons and OR staff, medical transcription specialists, coding teams, accounts receivable, and even front-desk staff.
Here are some of the key areas that lengthen the claims process in ASCs.
Key challenges preventing ASCs from timely claims submissions
1. Using the wrong templates
Whether it’s Medicare or a private insurer, each payer has their own preference for how a claim is presented to them for review and approval. But plans often change and it is often impossible for busy ASC staff to keep up with all of them. As a result, ASCs often use boilerplate templates to submit the details of each surgical procedure for reimbursement.
Unfortunately, any information deemed missing or incorrect may result in a claims denial or request for resubmission. In these cases, surgery centers may experience a big hit to their revenue.
2. Incorrect coding for procedures
Incorrect coding is one of the leading reasons for claims denials. There is a long list of CPT and ICD codes to comb through and it can be a struggle for coding teams to get it right for every surgery. This is a bigger challenge when patient modifiers are involved.
There may be some relief when third-party vendors are involved, but the process is still largely manual and may need additional verification by the surgery center. Additionally, ASC codes must match the codes that a provider submits for the same procedure. This matching adds another step to the overall process.
3. Errors in dictation and transcription for operative notes
Operative notes or “op notes” are critical to an ASC’s claim submission. The operating surgeon will have to convey his thoughts on:
- Each patient’s medical history and clinical presentation
- Why a specific procedure was chosen
- What implants were chosen and why
- Deviations or modifications from a standard surgical procedure based on medical needs
Surgeons usually dictate their op notes directly to a medical transcriber or send them voice memos. More recently, many surgeons use speech-to-text apps to help them transcribe their words. These methods have been tolerated as a necessary ‘evil’ in lieu of a better alternative.
A 2018 study of two healthcare organizations found that an error rate for speech recognition dictations had a 7.4% error rate after initial dictation, 0.4% after a transcriptionist review, and 0.3% in final, signed versions. At each stage, 15.8% of errors involved clinical information1.
Manual medical transcription relies on the skill, expertise, and accuracy of each transcriber. If they cannot interpret the surgeon’s words accurately, multiple rounds of edits may follow before final approval.
Text-to-speech software can help speed up the process a little because surgeons can step out between surgeries to dictate into a phone and share with the transcription team. However, speech-to-text software can result in inaccuracies based on how well the technology understands a specific surgeon’s notes, medical terms, accent, and more. The software can also be less efficient in noisy environments. Busy surgeons rushing to the next surgery may forget to mention a modifier or provide more detail about a procedure, which can cause further delays in finalizing the op notes.
4. Wrong or missing implant information
Billing a patient and filing a claim for reimbursement needs an accurate list of the implants used in the surgery. Whenever a procedure is completed, OR staff note down or scan barcodes for each implant on their packaging. This data is stored on a centralized database, usually integrated with an EMR or EHR.
With surgery volumes on the rise, there is greater pressure on staff to improve turnaround times and ready each OR for the next surgery. Without a simpler system in place, there is the possibility of forgetting to write down or scan all the implants, and later, not attaching the right list of implants to the op notes and claims submission.
5. Compiling information from fragmented sources
Filing a claim for a surgical procedure often involves teams of people putting information together from various sources. Patient data, for example, may be located on a manual form or entered into an EMR. Surgical op notes may be on speech-to-text software or have many versions floating around for review via email. Implant information is barcoded and stored in a centralized database. The coding team has access to all ICD and CPT codes and templates for billing and reimbursement may be located in accounts receivable (AR). Juggling all these various sources of information can result in delays and errors. ASCs need a streamlined solution to help submit claims and receive payments faster
ASCs need a high-quality and easy way to accurately digitize all data required for claims — like PRO-MAPP. Using PRO-MAPP, it’s common to see surgery centers reduce time from service to billing by 68%.
PRO-MAPP is a digital platform that takes the struggle out of creating a claims package for each surgery.
- Hundreds of preloaded templates for you to customize according to your center’s needs
- An automated workflow with a user-friendly interface that can be accessed on a computer, tablet, or smartphone
- Automatic coding for all procedures based on your center and surgeons’ preferences
- Almost-final op notes generated automatically after surgery based on intraoperative surgical decisions — surgeons never have to dictate again! You can also add modifiers and other relevant information
- The ability to scan implant barcodes right from the same app
- All your claims documents stored in one convenient app
1. “Analysis of Errors in Dictated Clinical Documents Assisted by Speech Recognition Software and Professional Transcriptionists”. JAMA Network Open, 2018 Jul: 1(3) Li Zhou, MD, PhD et al.
2. CDC. (2021, November 22). What is venous thromboembolism? Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/dvt/facts.html
3. Raynor, M., Pietrobon, R., Guller, U., & Higgins, L. (2005). Cryotherapy After ACL Reconstruction -A Meta-analysis. The Journal of Knee Surgery, 18(02), 123–129. https://doi.org/10.1055/s-0030-1248169
4. Cohn, B. T., Draeger, R. I., & Jackson, D. W. (1989). The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. The American Journal of Sports Medicine, 17(3), 344–349. https://doi.org/10.1177/036354658901700306
5. Capps, S. G., & Brook, M. (2009). Cryotherapy and intermittent pneumatic compression for soft tissue trauma. Athletic Therapy Today: The Journal for Sports Health Care Professionals, 14(1), 2–4. https://doi.org/10.1123/att.14.1.2
6. Crawford, D. A., Andrews, R. L., Morris, M. J., Hurst, J. M., Lombardi, A. V., Jr, & Berend, K. R. (2020). Ambulatory portable pneumatic compression device as part of a multimodal aspirin-based approach in prevention of venous thromboembolism in outpatient total knee arthroplasty. Arthroplasty Today, 6(3), 378–380. https://doi.org/10.1016/j.artd.2020.05.007