Benchmarks can help ASCs focus on big-picture, revenue-boosting changes, according to MedEvolve Executive Vice President Matt Seefeld.
MedEvolve provides data-driven solutions to improve physician practices' transparency, automation and accountability. Mr. Seefeld shared his tips for improving billing and collections with Becker's ASC Review.
Note: Responses have been edited for style and clarity.
Question: What are three benchmarks ASCs should set to improve billing and collections?
Matt Seefeld: The first area to look at is first-pass denials. It's critical to really understand why an insurance company is rejecting a claim. A lot of denials come from basic process breakdowns in the revenue cycle that can be easily prevented. Issues like verification of benefits and eligibility and no authorization can be prevented with a strong financial clearance process. Ensuring processes and technology used at scheduling, preregistrations and patient check-in are aligned with industry best practices will ensure the right information is collected from the patient and the insurance company up front to minimize financial risk going forward.
Another major benchmark for ASCs is net collection rate. ASCs need to look at how much they are collecting on each dollar they are owed by the insurance company and the patient. The national benchmark is about $0.96 on the dollar, so if an ASC is collecting less than that, they need to consider what avoidable adjustments they are writing off and make appropriate changes. Automated RCM transparency and analytics solutions can help ASCs get a better picture of the data points behind their net collection rates so they can spend more time focusing on implementing the appropriate changes to improve collections.
Collections prior to service or at the point of service is especially important for ASCs because ASCs naturally have a higher cost of service. The likelihood of collecting from a patient drops materially every day after a patient is seen and treated, so surgery centers need to be vigilant and understand the potential risk for the patient portion of the bill. ASCs should provide estimates before the surgery and ask for deposits — at a minimum — to help recoup payment. Offering discounts for advance payment in full and making sure you have a credit card on file are other ways to ensure you get paid.
Q: How can ASC administrators ensure those benchmarks are met? What does it take for ASCs to reach their goals?
MS: Access to accurate, automated, real-time data will help ASCs ensure that these benchmarks are met. By having a system in place that reduces the amount of time spent mining data and building reports, ASCs can spend more time focusing on the bigger picture changes to make to boost revenue.
Q: What are the key components of a successful accounts receivable strategy?
MS: Understanding the estimated reimbursement you expect to collect and making sure you are prioritizing high-value claims are the most crucial parts of a successful A/R plan. Quickly segmenting denied claims is key so you don't miss filing and appeal timelines. Billing staff will save valuable time by focusing on the claims that need to be worked today — over 80 percent of claims in open A/R don't need to be looked at now. Instead, your RCM team should concentrate on the 10 percent to 15 percent of claims that require intervention today. This will save you money on staff expenses and protect your revenue by keeping the right focus.
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