Here are six ways to collect full payment for as many of your center's cases as possible.
1. Know the electronic pathway of claim submissions to every payor. Lisa Rock, president and CEO of National Medical Billing Services, recommends that billing managers chart the path of electronic claim submissions for each payor. Electronic claims are sent from providers to the provider's EDI company and, in some cases, on to several trading partners before the claim reaches the payor. The longer the path the claim takes, the more opportunity for errors. For example, an ASC may use an EDI company that does not have a direct contract with a certain payor. If that is the case, the EDI company would send the claim to a trading partner, which may or may not have a direct contract with the payor. If the trading partner does not have a direct contract, the claim would go to yet another trading partner before reaching the payor. Knowing the pathway of claims can also give billers a better idea of how long claims will take to reach payors, says Ms. Rock.
Billing managers can begin to chart the path by following a claim from the healthcare provider to the provider's EDI company and then determine if the claim goes directly to the payor or to an additional clearing house or trading partner. "For each payor, call your EDI provider and ask if they have a direct contract with that payor. If they do not, ask where they send the claims next," says Ms. Rock. "After you determine where it goes next, call there and ask if they have a direct contract with the payor, and so on."
From: 16 ASC Coding, Billing and Collections Best Practices
2. Disclose all necessary information in the operative note. Accuracy and completeness of the operative note is essential in determining what you are going to be paid, says Caryl Serbin, president and founder of Serbin Surgery Center Billing. In a column submitted to Becker's ASC Review, Ms. Serbin said the ASC should provide a quiet and comfortable area for the surgeon to dictate. The center can also educate surgeons on how certain areas of the operative note need to be clarified, she said. Procedures that were performed which can often provide additional reimbursement are frequently not identified in the operative note, as well as not mentioning implants and ancillary procedures provided. A quote attributed to CMS advised, "If it's not documented, it never happened." According to Ms. Serbin, areas often needing additional attention for dictation are:
• Bilateral or multiple procedures
• Identification of surgical site, e.g., fingers, toes (needed for modifiers)
• Specific areas treated, e.g., medial or lateral compartment
• Detailed implant information
• Ancillary procedures performed
• Deviation from normal, i.e., more time, complications
• Postoperative pain management details
From: 6 Areas of Focus for Collecting Full Payment: Critical Steps to Take Prior to Billing (Part 1)
3. Follow a clear collection policy. According to Michael Orseno, revenue cycle director for Regent Surgical Health, ASCs with the best collection rates almost always follow a collection policy that details actions that need to be taken over the course of the payment cycle. "Most of our centers send three statements to their patients: the first at day one of patient responsibility, the second at 30 days outstanding and the final one at 60 days outstanding," he says. "After the third statement, the patients are put into pre-collections for a period of time, and then on to bad debt collections at 90-120 days." He adds that all patients receive a telephone call, and patients with a balance over a center-specific threshold will receive two additional calls. When patients are eventually sent to bad debt collections, centers should send a letter informing the patients of the ASC's action.
From: Practical Guidance on 3 Top Revenue Cycle Challenges
4. Determine if collection problems are an external or internal issue. According to April Sackos, director of business office operations for Meridian Surgical Partners, ASCs should review aged accounts, denial logs and electronically transmitted claims reports to determine whether the issue is internal or external. "I would recommend looking at your high dollar items in your 90-day bucket," she says. "Drill it down by payor and look at the account notes to identify any problem areas."
From: 3 Steps to Identify and Reduce Collections Problems
5. Make resubmission of denied claims a priority. David Wold, CEO of Healthcare Information Services in Park Ridge, Ill., says every ASC should ask, "Has the billing office been instructed to make it a priority to immediately rescrub and resubmit denied?" Mr. Wold says the actual error might be something simple like the wrong social security number or incorrect insurance information, which can easily be fixed if someone properly works the claim.
From: 9 Ways to Improve Your Practice's Revenue Cycle
6. Spot-check employees' work. Someone should be overseeing the work of billing employees by regularly spot-checking the "explanation of benefits" reports coming back from insurers. Sarah Wiskerchen, MBA, CPC, consultant with Karen Zupko and Associates, recommends doing this weekly. "This shows the staff that you're paying attention and that you expect timely appeals and corrections," she says.
From: 10 Billing and Collections Best Practices for Orthopedic and Spine Practices
1. Know the electronic pathway of claim submissions to every payor. Lisa Rock, president and CEO of National Medical Billing Services, recommends that billing managers chart the path of electronic claim submissions for each payor. Electronic claims are sent from providers to the provider's EDI company and, in some cases, on to several trading partners before the claim reaches the payor. The longer the path the claim takes, the more opportunity for errors. For example, an ASC may use an EDI company that does not have a direct contract with a certain payor. If that is the case, the EDI company would send the claim to a trading partner, which may or may not have a direct contract with the payor. If the trading partner does not have a direct contract, the claim would go to yet another trading partner before reaching the payor. Knowing the pathway of claims can also give billers a better idea of how long claims will take to reach payors, says Ms. Rock.
Billing managers can begin to chart the path by following a claim from the healthcare provider to the provider's EDI company and then determine if the claim goes directly to the payor or to an additional clearing house or trading partner. "For each payor, call your EDI provider and ask if they have a direct contract with that payor. If they do not, ask where they send the claims next," says Ms. Rock. "After you determine where it goes next, call there and ask if they have a direct contract with the payor, and so on."
From: 16 ASC Coding, Billing and Collections Best Practices
2. Disclose all necessary information in the operative note. Accuracy and completeness of the operative note is essential in determining what you are going to be paid, says Caryl Serbin, president and founder of Serbin Surgery Center Billing. In a column submitted to Becker's ASC Review, Ms. Serbin said the ASC should provide a quiet and comfortable area for the surgeon to dictate. The center can also educate surgeons on how certain areas of the operative note need to be clarified, she said. Procedures that were performed which can often provide additional reimbursement are frequently not identified in the operative note, as well as not mentioning implants and ancillary procedures provided. A quote attributed to CMS advised, "If it's not documented, it never happened." According to Ms. Serbin, areas often needing additional attention for dictation are:
• Bilateral or multiple procedures
• Identification of surgical site, e.g., fingers, toes (needed for modifiers)
• Specific areas treated, e.g., medial or lateral compartment
• Detailed implant information
• Ancillary procedures performed
• Deviation from normal, i.e., more time, complications
• Postoperative pain management details
From: 6 Areas of Focus for Collecting Full Payment: Critical Steps to Take Prior to Billing (Part 1)
3. Follow a clear collection policy. According to Michael Orseno, revenue cycle director for Regent Surgical Health, ASCs with the best collection rates almost always follow a collection policy that details actions that need to be taken over the course of the payment cycle. "Most of our centers send three statements to their patients: the first at day one of patient responsibility, the second at 30 days outstanding and the final one at 60 days outstanding," he says. "After the third statement, the patients are put into pre-collections for a period of time, and then on to bad debt collections at 90-120 days." He adds that all patients receive a telephone call, and patients with a balance over a center-specific threshold will receive two additional calls. When patients are eventually sent to bad debt collections, centers should send a letter informing the patients of the ASC's action.
From: Practical Guidance on 3 Top Revenue Cycle Challenges
4. Determine if collection problems are an external or internal issue. According to April Sackos, director of business office operations for Meridian Surgical Partners, ASCs should review aged accounts, denial logs and electronically transmitted claims reports to determine whether the issue is internal or external. "I would recommend looking at your high dollar items in your 90-day bucket," she says. "Drill it down by payor and look at the account notes to identify any problem areas."
From: 3 Steps to Identify and Reduce Collections Problems
5. Make resubmission of denied claims a priority. David Wold, CEO of Healthcare Information Services in Park Ridge, Ill., says every ASC should ask, "Has the billing office been instructed to make it a priority to immediately rescrub and resubmit denied?" Mr. Wold says the actual error might be something simple like the wrong social security number or incorrect insurance information, which can easily be fixed if someone properly works the claim.
From: 9 Ways to Improve Your Practice's Revenue Cycle
6. Spot-check employees' work. Someone should be overseeing the work of billing employees by regularly spot-checking the "explanation of benefits" reports coming back from insurers. Sarah Wiskerchen, MBA, CPC, consultant with Karen Zupko and Associates, recommends doing this weekly. "This shows the staff that you're paying attention and that you expect timely appeals and corrections," she says.
From: 10 Billing and Collections Best Practices for Orthopedic and Spine Practices