Receiving the correct reimbursement for procedures performed in ASCs depends on examining steps in the revenue cycle process, according to Jessica Nelson, director of revenue cycle services at Surgical Information Systems.
She shared the following tips on how to improve the ASC preauthorization process on Surgical Information Systems' blog:
1. Collect necessary information. Preauthorization specialists should collect a patient's background information, including their insurance details, diagnosis, procedure type, date of surgery and the name of the surgeon performing the procedure.
2. Verify returning patients' information. Even if a patient is a repeat customer to the ASC, the preauthorization specialist should confirm the patient's personal and insurance information.
3. Confirm payer contracts. Speaking with the payer representatives about preauthorization communication preferences can streamline the process.
4. Time benefit verification. Reaching out to payers 48 hours before a surgery ensures a patient's benefits are accurate and up to date.
5. Be aware of common surgeon practices. Accounting for differences and common changes a surgeon may make for a procedure allows the preauthorization specialist to authorize the appropriate codes.
6. Track changes to payer requirements. Ensure the ASCs business office leadership is tracking correspondences from payers and noting any changed rules.
7. Train specialists. Giving preauthorization specialists adequate training when they join the business office team helps them successfully complete the preauthorization process.
8. Monitor performance. Auditing and monitoring your preauthorization specialist's performance to identify problems such as denied claims can help them fix the issues through recommended training or providing support.