An optimally functioning revenue cycle is crucial to an ambulatory surgery center's success.
Brenda Myers, associate senior vice president of business office operations for ASD Management, works closely with ASC business offices to improve policies, procedures, coding and compliance to maximize revenue.
Here are Ms. Myers' seven tips for revenue cycle best practices.
1. Know your benefits. One of the biggest keys to collecting all due revenue is having coders be familiar with managed care contracts. Billers cannot always refer to the contracts, so Ms. Myers recommends loading the contracts into the accounts receivable software system.
"If you don't load your managed care contracts and you have your billers only post per explanation of benefits and not by looking at the contract, you can lose money," she says.
2. Avoid unlisted codes. If a physician dictates a procedure in an operative note that does not fall under a current procedural technology code, then a coder may have to resort to using an unlisted code. Since Medicare does not reimburse for unlisted codes, these codes cost centers profits.
"You could be leaving money on the table," she says.
While unlisted codes cannot be completely avoided, centers can take steps to make sure they are not unnecessarily used. For instance, Ms. Myers says, a solution could be educating a physician on a similar technique which does have an assigned code or helping the physician use proper supporting documentation in an operative report to qualify for a code.
3. Negotiate increase for repeat procedures. Surgery center administrators should periodically assess the top 25 procedures performed at the center and weigh the cost against the reimbursement. If you are not receiving enough money on a frequently performed procedure to make it profitable, then talk with commercial payors about increasing that particular code's rate.
"They won't give you an across-the-board increase," Ms. Myers says, "but you can say, 'We have increased these shoulder scopes and done 50 more this year, and it's costing us this much to do.' They may go back to the drawing board and increase a particular CPT code."
Showing your payors that you are unable to perform a frequent procedure without additional reimbursement can give them an incentive to make the surgery more financially worthwhile, thus increasing your overall revenue.
4. Encourage timely dictation. You cannot bill a claim without an operative report or it is considered fraudulent, and delayed operative notes increase the number of billing days and decrease revenue. To avoid this problem, Ms. Myers says to impress upon your physicians the importance of dictating notes quickly.
"Teach your doctors the sooner they dictate, the sooner we can generate revenue," she says. "It's important to stay on top of dictating in a timely fashion."
5. Review managed care contract coverage. Once or twice a year, an ASC's managed care contracts should be reviewed, Ms. Myers says. Staff members should look at the procedures most often performed and which payors are covering patients. You can determine any gaps in your patient coverage.
"All of a sudden you see there's a new employer in town, and he's contracting with United Healthcare," she says, of a hypothetical discovery this review can detect. "Your surgery center has never contracted with United Healthcare, so you are turning away new patients because the deductible is too high."
You may see a new payor contract could be beneficial to picking up new patients and can begin negotiations.
6. Monitor clearing house claims. Most surgery centers bill electronically for faster turnaround, but it is still important for billers to continuously monitor clearing house claims, Ms. Myers says.
Monitoring the electronic claims allows billers to discover problems before the current claims age and fix them for quicker turnaround. "If there is a glitch in a case at the clearing house level or payor level, you can catch it then, too," she says.
By monitoring these claims, billers can also read the error reports to learn which claims cause problems and how to avoid those problems in the future.
7. Schedule in advance. Attempt to schedule all cases one to two weeks in advance, if possible, Ms. Myers says. Early scheduling allows an ASC to verify a case immediately and obtain member benefits.
Also, notify the patient ahead of time how much they are responsible for paying and to bring money in the day of surgery, whether it is cash, credit or care credit.
"Collecting up front reduces bad debt turnover on the back end," she says. "Industry standards have shown bad debt is harder to collect afterwards."
To make early scheduling possible, eliminate the communication gap that can occur between surgery center and physician office schedulers. "We have a schedulers' luncheon," she says. "It's an opportunity for our schedulers in the surgery center to meet and greet with schedulers at the doctor's office and build a bond."
More Articles on Coding, Billing and Collections:
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Brenda Myers, associate senior vice president of business office operations for ASD Management, works closely with ASC business offices to improve policies, procedures, coding and compliance to maximize revenue. Here are Ms. Myers' seven tips for revenue cycle best practices.
1. Know your benefits. One of the biggest keys to collecting all due revenue is having coders be familiar with managed care contracts. Billers cannot always refer to the contracts, so Ms. Myers recommends loading the contracts into the accounts receivable software system.
"If you don't load your managed care contracts and you have your billers only post per explanation of benefits and not by looking at the contract, you can lose money," she says.
2. Avoid unlisted codes. If a physician dictates a procedure in an operative note that does not fall under a current procedural technology code, then a coder may have to resort to using an unlisted code. Since Medicare does not reimburse for unlisted codes, these codes cost centers profits.
"You could be leaving money on the table," she says.
While unlisted codes cannot be completely avoided, centers can take steps to make sure they are not unnecessarily used. For instance, Ms. Myers says, a solution could be educating a physician on a similar technique which does have an assigned code or helping the physician use proper supporting documentation in an operative report to qualify for a code.
3. Negotiate increase for repeat procedures. Surgery center administrators should periodically assess the top 25 procedures performed at the center and weigh the cost against the reimbursement. If you are not receiving enough money on a frequently performed procedure to make it profitable, then talk with commercial payors about increasing that particular code's rate.
"They won't give you an across-the-board increase," Ms. Myers says, "but you can say, 'We have increased these shoulder scopes and done 50 more this year, and it's costing us this much to do.' They may go back to the drawing board and increase a particular CPT code."
Showing your payors that you are unable to perform a frequent procedure without additional reimbursement can give them an incentive to make the surgery more financially worthwhile, thus increasing your overall revenue.
4. Encourage timely dictation. You cannot bill a claim without an operative report or it is considered fraudulent, and delayed operative notes increase the number of billing days and decrease revenue. To avoid this problem, Ms. Myers says to impress upon your physicians the importance of dictating notes quickly.
"Teach your doctors the sooner they dictate, the sooner we can generate revenue," she says. "It's important to stay on top of dictating in a timely fashion."
5. Review managed care contract coverage. Once or twice a year, an ASC's managed care contracts should be reviewed, Ms. Myers says. Staff members should look at the procedures most often performed and which payors are covering patients. You can determine any gaps in your patient coverage.
"All of a sudden you see there's a new employer in town, and he's contracting with United Healthcare," she says, of a hypothetical discovery this review can detect. "Your surgery center has never contracted with United Healthcare, so you are turning away new patients because the deductible is too high."
You may see a new payor contract could be beneficial to picking up new patients and can begin negotiations.
6. Monitor clearing house claims. Most surgery centers bill electronically for faster turnaround, but it is still important for billers to continuously monitor clearing house claims, Ms. Myers says.
Monitoring the electronic claims allows billers to discover problems before the current claims age and fix them for quicker turnaround. "If there is a glitch in a case at the clearing house level or payor level, you can catch it then, too," she says.
By monitoring these claims, billers can also read the error reports to learn which claims cause problems and how to avoid those problems in the future.
7. Schedule in advance. Attempt to schedule all cases one to two weeks in advance, if possible, Ms. Myers says. Early scheduling allows an ASC to verify a case immediately and obtain member benefits.
Also, notify the patient ahead of time how much they are responsible for paying and to bring money in the day of surgery, whether it is cash, credit or care credit.
"Collecting up front reduces bad debt turnover on the back end," she says. "Industry standards have shown bad debt is harder to collect afterwards."
To make early scheduling possible, eliminate the communication gap that can occur between surgery center and physician office schedulers. "We have a schedulers' luncheon," she says. "It's an opportunity for our schedulers in the surgery center to meet and greet with schedulers at the doctor's office and build a bond."
More Articles on Coding, Billing and Collections:
Litton & Giddings Radiological Associates Announces HIPAA Breach of 13K Patient Records
Outsourced Billing Can Have Numerous Benefits for Physician Practices
Medicare RACs Recoup Record-High $657M in Third Quarter