Caryl Serbin, RN, president of Serbin Surgery Center Billing, offers 12 ways for an ASC to immediately improve profitability.
1. Review fee schedules at least annually. Managed care and Medicare rates change over time. "It's unbelievable how many ASCs don't update their fee schedules," Ms. Serbin says. "A great deal of money often gets left on the table."
2. Appeal denials. "You need to appeal denials to highest available level," Ms. Serbin says. When an ASC doesn't chase denials, payors increase the denial rate. "If the payor thinks you accept denials, they will give you more," she says.
3. Be aggressive with collections. Successfully collecting on bills requires knowing what to say, when to say it and when to follow up. "It's a matter of timing," Ms. Serbin says.
4. Collect out-of-pocket charges upfront. If you don't collect beforehand, you're less likely to get paid fully. "It's almost a cultural thing," Ms. Serbin says. "Patients think it's okay not to pay the bill."
5. Verify insurance. When money gets tight, ASCs try to do more with less and drop time-intensive processes like verifying patients' insurance. "This saves a lot of time, but on the financial side it'll kill you," Ms. Serbin says. One or two patients without coverage can amount to thousands of dollars in unpaid bills.
6. Know accounts receivable trends. Trending A/R data will help you pinpoint the weak spots in your operation. "Everybody oversimplifies," Ms. Serbin says. "The data must be exact to be useful." She adds: "You have to know how you take data from your software and put it into a meaningful format."
7. Understand IT systems. Get training from your software company so you know what your system can and cannot do. Vendors offer software upgrades to accommodate changes such as new reimbursement rates, but too few ASCs incorporate these changes, Ms. Serbin says.
8. Find efficient and experienced staff to do your billing. "The business office should be the last place you cut," Ms. Serbin says. A weak billing operation means a great deal of money is probably slipping through your fingers.
9. Perform audits regularly. Do internal audits monthly and an external audit yearly. This will put you on top of potential problems before they become overwhelming.
10. Keep up-to-date with claims. "If you fall behind it's hard to catch up," Ms. Serbin says. "If you had 20 things to do on Monday that didn't get completed, on Tuesday you now have 35 things." When staff members are that far behind, crucial functions are dropped. "The claims don't get sent out or they are not followed up on," she says.
11. Check up on clearinghouses. If you use third-party clearinghouses to submit claims, regularly check to make sure the claim was paid and didn't get stuck somewhere along the way, she says.
12. Use trained coders. Make sure your coders receive regular training and develop best practices for coding, Ms. Serbin says. If your coders aren't optimizing coding (while still remaining compliant, this is another area where a lot of money can be left on the table.
Learn more about Serbin Surgery Center Billing.
Read more practical guidance from Caryl Serbin:
- 8 Quick Tips for Picking the Best Insurance Plans for Your ASC
- 12 Best Practices for Analyzing Business Terminology in Payor Contracts
- ASC Coding Guidance: Superficial Sentinel Lymph Node Biopsy