Here are five tips from ASC experts on how to maximize ASC collections and ensure proper and full reimbursement.
1. Obtain surgeons' support. In pre-surgery office visits, surgeons may be advising the patient, "You don't have to worry about the bill until after the surgery is done," says Caryl Serbin of Serbin Surgery Center Billing. This may be all well and good for the surgeon's office, which will see the patient again, but the ASC has only a one-time visit so upfront collections are crucial. To prevent misunderstandings on how fees will be collected, provide the physician's office with the ASC's financial policies and procedures.
From: 8 Ways ASCs Can Improve Patient Collections
2. Prioritize accounts. Make sure that your staff is prioritizing which accounts they work first, writes April Sackos, director of business office operations for Meridian Surgical Partners. There are many ways to prioritize your accounts. One method that works is:
1. Work the high dollar accounts (over $1,000.00) in the 90-, 60- and 30-day buckets.
2. Work the $999.00 and under in the 90-, 60- and 30-day buckets.
3. Work the 120-day and over bucket, reviewing the high dollar items first.
From: 3 Steps to Identify and Reduce Collections Problems
3. File claims in a timely manner. Billing and collections go hand in hand, says Ms. Sackos. It is critical for your staff to be familiar with your payor contracts regarding their requirements for the timely filing of claims. Develop solid procedures at your ASC for capturing charges and the necessary claim information on procedures to file claims within the required timelines. Verify that claims that need to be submitted in hardcopy form and going out in a timely manner with the supporting documentation and not going electronically. Verify that your staff is reconciling their electronically transmitted claim reports. Many times a claim was rejected by a payor during the electronic transmission process and is just sitting out there.
From: 6 Common Collections Mistakes and How to Avoid Them
4. Explain a patient's financial obligations three days before service. By the time your facility calls the patient to explain the payment, the administrative staff should already have insurance and contact information from the physician. This information will tell your facility how much the patient will owe for the facility fee. Since it can be a challenge to reach patients at home, Rob Morris, vice president of marketing and new business development for GE Capital's CareCredit, recommends ASCs call three days before the procedure to explain the patient's financial responsibility. "They're going to need to say, 'Make sure you don't drink any fluids, you need to be an hour early, don't bring any jewelry or your watch, and we just checked over your insurance and you have an obligation of $600 towards the facility fee. How would you like to pay for that?'" The financial obligation should be a prerequisite for service just like the physical requirements.
Cathy Meredith, vice president of finance for ASCOA, agrees there should be no discussions of what the patient owes at the front desk. "The only reason you should bill after the surgery is if there are changes because of [complications during surgery]," she says. "I say again and again to our surgery centers that your best chance of collecting money is on the day of service. Once the patient is better and leaves the center, your chance of collecting decreases exponentially."
Mr. Morris says explaining financial obligations prior to surgery will reduce instances where the patient arrives at the center without knowing about the required payment. "Try and get the patient to commit," he says. "If you can, take the credit card number over the phone."
From: 7 Ways to Ensure Payment Without Damaging Patient Relationships
5. Don't get burned by repeat non-paying patients. With an increase in high deductible plans and general economic challenges, more patients are having their bills sent to collections, and this will often lead an ASC to eventually write-off unpaid co-pays and deductibles. Considering that patients can be repeat customers to an ASC, some non-paying patients will eventually return. "There's nothing worse than having someone you did a procedure for never pay, and now you're seeing them again and you're likely just going to take another hit," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions.
The solution: Develop a policy and procedure followed by schedulers where the scheduler looks on a list or a note within your billing system during the scheduling process, and identifies if a patient previously had a balance the ASC wrote off or is currently in the active collections process. "Then have the [scheduler] educate patients that they're not having another procedure unless they pay the outstanding balance, and remember to avoid any issues which could be classified as abandonment," says Mr. Voithofer. "Putting this tool in place is easy and could generate significant revenues — it can be a few hundred dollars written off with each account, and that adds up very quickly."
From: 3 Changes to Make Today to Boost Your ASC's Collections
1. Obtain surgeons' support. In pre-surgery office visits, surgeons may be advising the patient, "You don't have to worry about the bill until after the surgery is done," says Caryl Serbin of Serbin Surgery Center Billing. This may be all well and good for the surgeon's office, which will see the patient again, but the ASC has only a one-time visit so upfront collections are crucial. To prevent misunderstandings on how fees will be collected, provide the physician's office with the ASC's financial policies and procedures.
From: 8 Ways ASCs Can Improve Patient Collections
2. Prioritize accounts. Make sure that your staff is prioritizing which accounts they work first, writes April Sackos, director of business office operations for Meridian Surgical Partners. There are many ways to prioritize your accounts. One method that works is:
1. Work the high dollar accounts (over $1,000.00) in the 90-, 60- and 30-day buckets.
2. Work the $999.00 and under in the 90-, 60- and 30-day buckets.
3. Work the 120-day and over bucket, reviewing the high dollar items first.
From: 3 Steps to Identify and Reduce Collections Problems
3. File claims in a timely manner. Billing and collections go hand in hand, says Ms. Sackos. It is critical for your staff to be familiar with your payor contracts regarding their requirements for the timely filing of claims. Develop solid procedures at your ASC for capturing charges and the necessary claim information on procedures to file claims within the required timelines. Verify that claims that need to be submitted in hardcopy form and going out in a timely manner with the supporting documentation and not going electronically. Verify that your staff is reconciling their electronically transmitted claim reports. Many times a claim was rejected by a payor during the electronic transmission process and is just sitting out there.
From: 6 Common Collections Mistakes and How to Avoid Them
4. Explain a patient's financial obligations three days before service. By the time your facility calls the patient to explain the payment, the administrative staff should already have insurance and contact information from the physician. This information will tell your facility how much the patient will owe for the facility fee. Since it can be a challenge to reach patients at home, Rob Morris, vice president of marketing and new business development for GE Capital's CareCredit, recommends ASCs call three days before the procedure to explain the patient's financial responsibility. "They're going to need to say, 'Make sure you don't drink any fluids, you need to be an hour early, don't bring any jewelry or your watch, and we just checked over your insurance and you have an obligation of $600 towards the facility fee. How would you like to pay for that?'" The financial obligation should be a prerequisite for service just like the physical requirements.
Cathy Meredith, vice president of finance for ASCOA, agrees there should be no discussions of what the patient owes at the front desk. "The only reason you should bill after the surgery is if there are changes because of [complications during surgery]," she says. "I say again and again to our surgery centers that your best chance of collecting money is on the day of service. Once the patient is better and leaves the center, your chance of collecting decreases exponentially."
Mr. Morris says explaining financial obligations prior to surgery will reduce instances where the patient arrives at the center without knowing about the required payment. "Try and get the patient to commit," he says. "If you can, take the credit card number over the phone."
From: 7 Ways to Ensure Payment Without Damaging Patient Relationships
5. Don't get burned by repeat non-paying patients. With an increase in high deductible plans and general economic challenges, more patients are having their bills sent to collections, and this will often lead an ASC to eventually write-off unpaid co-pays and deductibles. Considering that patients can be repeat customers to an ASC, some non-paying patients will eventually return. "There's nothing worse than having someone you did a procedure for never pay, and now you're seeing them again and you're likely just going to take another hit," says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions.
The solution: Develop a policy and procedure followed by schedulers where the scheduler looks on a list or a note within your billing system during the scheduling process, and identifies if a patient previously had a balance the ASC wrote off or is currently in the active collections process. "Then have the [scheduler] educate patients that they're not having another procedure unless they pay the outstanding balance, and remember to avoid any issues which could be classified as abandonment," says Mr. Voithofer. "Putting this tool in place is easy and could generate significant revenues — it can be a few hundred dollars written off with each account, and that adds up very quickly."
From: 3 Changes to Make Today to Boost Your ASC's Collections