When it comes to billing, if you are not measuring it, you are not managing it. The key to an effective billing process, and higher revenues, is generating data, accurately analyzing that data, and following through on outstanding claims. Sounds simple? In theory, yes, however for many busy ambulatory surgery centers managing billing processes is a constant struggle and the reason for lost revenues. To help facilities get a better handle on billing as we kick off a new year, consider the following tips for effectively managing billing processes.
1. Don't overlook scheduling. Scheduling is a critical piece of the billing process from both a patient flow and billing perspective. Scheduling conflicts can lead to canceled procedures, which translate to lost revenues. In the event a scheduler fails to confirm the availability of key resources (i.e. a piece of machinery for a specific procedure) additional revenue is lost as operating rooms are left sitting idle due to last-minute cancellations. Fortunately, technology exists that enables facilities to automate the scheduling process; some systems even allow information sharing between a physician's office and the facility.
2. Conduct insurance verification ahead of time. Verifying a patient's coverage, including any authorizations or pre-certifications, well in advance of a procedure will help facilities avoid needless billing delays. Automated solutions are available to aid in facilitating this process. Co-pays and other patient responsible portions such as deductibles also should be collected upfront.
3. Leverage an electronic health record. EHR systems that feed information to a billing department or billing services partner provide valuable and necessary information. The ability to document details including what procedure was performed, any ancillary procedures performed, materials collected for pathology, etc., and share this information electronically with your facility's billing team eliminates unnecessary paper chases and speeds billing processes. Cases can be evaluated faster and procedure codes inputted along with any necessary modifiers for a procedure based on the operative notes provided within an EHR system. With transactions posted, claim files can be generated and submitted electronically to the insurance company.
4. Know your contracts. Billing staff should be familiar with payer contracts which will help minimize denials. To avoid denials, there are a number of applications available for facilities that ensure coding is correct prior to submitting claims. Another option, which is becoming very popular, is contracting with a billing services company. Outsourcing billing enables facilities to avoid time-consuming coding issues completely as the billing services company takes over the responsibility for ensuring cases are properly coded and processed. Billing services staff are also responsible for follow-up, monitoring reports to make sure outstanding AR is not aging beyond a reasonable amount of time, as well as assisting with reporting processes. Using a billing services company is a very cost-effective way to run your facility's billing operations.
5. Monitor claims submissions. Monitoring claim submissions to make sure payments are made on time is an essential component of any billing process. Key to the process is understanding and monitoring the typical collection turnaround time for each payor. If payment is not received within a reasonable window based on past performance of that payer, that should serve as red flag for staff that something is wrong. With knowledge in hand, your facility's billing team can pursue collection activity by following up with the payer to determine the cause of delay and work to resolve the issue(s).
6. Stay on top of unbilled patient accounts. Patient accounts with balances should be monitored and billed on a regular basis. Facilities have an option to process electronic patient statements through a clearinghouse vendor from their practice management system or they can print paper claims right from their own facility. How often this is done can vary by facility; most facilities will do it weekly or bi-weekly. Your facility should be aware of the costs associated with collection activities to identify a cut-off point where balances can be written off to avoid pursuit of an amount that does not justify the costs associated with the activity — saving valuable time and money.
7. Measure and manage information. Two of the most critical components of a successful billing process are the measurement and management of information. Goals should be set for collection activity and for consistent reporting, and staff should be held accountable for acting upon that data. Collection activity should be followed-through from start to finish, not just after the insurance has been billed. It is important to note that collection starts at the beginning of a case, with any co-pays or other financial obligations identified to the patient upfront. This allows for greater efficiency and holds the billing team accountable, which creates a more effective and efficient billing process.
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