Billing can be a hassle for hospitals and ASC alike, and mistakes in claims submissions can be costly for health systems and patients.
Brooke Day, administrator at Hastings (Neb.) Surgical Center, spoke with Becker’s about the non-negotiable checkpoints every ASC needs to doublecheck before claims leave their in-house billing departments.
Ms. Brooke Day: 1. Two-person verification before submission: This is your first and best line of defense. Whether you’re using HST Pathways or AdvantX, two sets of eyes drastically reduce human error. Think of it as your built-in “gut check” before revenue gets left on the table.
2. Are the modifiers accurate and applicable?: Missing or incorrect modifiers are one of the most common reasons claims get denied. Are you billing multiple procedures on the same date? Are laterality or assistant-surgeon modifiers present where needed? If your coders aren’t checking, your [accounts recievable] report will. For example, we always confirm in ophthalmology cases that if the diagnosis code is a left, the modifier matches.
3. Contracted rates and Medicare/Medicaid secondary: Medicaid will never pay more than its allowable, even when it’s secondary. If your contracted rate exceeds that amount, you’re eating the difference — no appeal, no fix. That gap can add up to thousands of dollars per case. At our centers, we always adjust the contracted rate to match the Medicaid allowable for these patients. This one step has a direct impact on your cash collections as a percentage of net revenue. We also pre-review high-dollar cases with Medicaid secondary to ensure we’re not walking into a financial loss. Skipping this step leads to messy corrections, avoidable denials and tough questions during monthly financial reviews. Business office managers know the drill: Get ahead of it, or get ready to explain it.
4. Does the implant log match the charges?: The implant log isn’t just documentation — it’s directly tied to your revenue. If the log doesn’t match what’s billed at the CPT level, you’re either leaving money on the table or triggering denials. This is especially crucial in orthopedic and pain-driven ASCs, where implant costs can be significant. To stay ahead, we scan and save the implant record and invoice in a shared file for every single case. Before submitting the claim, we verify the amounts to ensure accuracy. This not only speeds up clean claim submission, but it also gives us a clear audit trail for appeals. Trying to hunt down missing implant data a month — or three — after the fact is a headache no one has time for. A few extra minutes upfront saves hours (and dollars) later.
5. Authorized code versus performed code: This is one of the easiest mistakes to make — and one of the hardest to fix after the fact. Always confirm that the CPT code authorized by the payer matches the procedure actually performed. If there’s a mismatch and no formal update or addendum, you’ll end up chasing appeals instead of posting payments. This is easily managed by entering pop-up notes or alerts on the account, and ideally, your two-person verification process includes someone reviewing those notes before claim submission. We do not submit claims until this is verified and corrected if needed. Our standard is simple: Send it right, or don’t send it at all. Accuracy here protects your reimbursement and avoids unnecessary delays.
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