Looking to give your ASC's bottom line a jolt? An evaluation of any of your center's revenue cycle functions could provide valuable insight into opportunities to make positive changes. Acting upon deficiencies will help achieve significant short- and long-term revenue gains and overall enhanced business performance.
Here are five areas of your ASC's revenue cycle worth focusing on for potential improvement.
1. Coding accuracy. A surefire way to delay getting paid or losing money your ASC rightfully deserves is failing to code properly. Coding errors often trigger denials. These require your ASC to determine the cause of the mistake (unless indicated by the payer) and file an appeal. Such efforts take time —and time equals money. They also prevent money from going into the bank sooner, which translates into lost interest. Downcoding errors can leave money on the table. If cash is tight, delayed or reduced payments can force ASCs to postpone critical investments. Upcoding errors can bring your ASC additional dollars, but when payers detect these mistakes, they will request repayment, possibly at an inopportune time. Such errors can also trigger fraud investigations if there is suspicion of incorrect coding.
2. Denial causes and trends. The saying, "You can never make the same mistake twice because the second time you make it, it's not a mistake, it's a choice" applies well to denied claims. Mistakes that trigger denials are bound to happen considering the amount of information payers require to approve a claim. Some denials may even occur accidentally.
When an ASC receives a denial, it is imperative to determine the reason(s) for the denial and file an immediate appeal, correcting the claim in the process. But it's also critical to ensure that the cause of the denial — whether it's people, process, and/or technology — is resolved going forward. Hopefully, the issue can be determined with the first denial. It may take a few denials to start seeing a trend, but once it is identified, take corrective action. Otherwise, you are essentially choosing to continue making the same mistake (and wasting the time and money associated with appealing in the process).
3. Claims follow-up. Even if your ASC submits a timely, accurate claim, payment may still be delayed. Reasons include a payer's backlog of payments, questionable payer practices, reports of "lost" claims that never reached payers and payer requests for additional information that may not have reached your ASC. Regardless of the reason, a delayed payment negatively affects business. Develop a process for identifying when payments seem delayed, following up with payers to determine the cause of a delay (if any), and addressing it.
4. Contract loading. How do you know if your ASC is getting paid correctly by payers? Simply getting paid is not necessarily proof. After all, payers can make mistakes when reimbursing your ASC for procedures performed.
That's why it is critical to ensure new or revised managed care contracts are loaded as soon as they take effect and that all members of your revenue cycle team have a full understanding of them. Doing so, and implementing a process for monitoring payments, will help ensure accurate reimbursement to your ASC and allow prompt corrective action if incorrect payments are received.
5. Days to bill. Here's another example of where inaction negatively affects the bottom line. Strive to submit all claims in less than five days, and that includes time for dictation of your surgeons' operative notes. Every day that a claim is not being worked on or submitted adds a day to the time between when you performed the procedure and were paid. These delays may then impact several of your ASC's metrics, including days to bill, days in accounts receivable (A/R), days to pay, and, ultimately, your A/R over 90 days.
If you wait too long to submit claims, you could even start running into timely filing deadlines. Missing these important deadlines will likely lead to a denial that you may not be able to appeal, unless you can provide proof that you tried to submit the claim before the deadline.
Angela Mattioda (amattioda@surgicalnotes.com) is vice president of revenue cycle management services for Surgical Notes RCM. Surgical Notes is a nationwide provider of revenue cycle solutions, including, transcription, coding, revenue cycle management (RCM), and document management applications for the ASC and surgical hospital markets. Mattioda oversees the SNBilling RCM service, the newest component of Surgical Notes' complete end-to-end revenue cycle solution offering.