Short-staffed in IT and the business office, ambulatory surgery centers (ASCs) and other providers often seek ways to increase profitability without disrupting workflow or adding resource hours. Part one of this revenue cycle management (RCM) series focused on pre-registration, medical necessity checks, appointment call abandon rate, aged accounts receivable (A/R) and charge description master review as areas to recoup lost dollars. Part two will shed light on five additional tactics to recover revenue.
1. Payer contract review: When were your payer contracts last updated? These should be reviewed in detail annually considering typical payer contracts outline the discounted rates for your ASC’s most commonly performed procedures. If your patient population has become more complex, and you did not align these changes with payer contracts, you could be losing additional reimbursement. To gain insight and perspective on what procedures to target for payer contract negotiation, run usage reports to identify volumes for your top 20 performed procedures. This report will give your CFO and the facility an advantage in payer contract discussions.
2. Denials analysis: Do a deep data dive on your top 10 denial codes and identify the payer for each. Determine the root cause(s) for each denial and correct faulty processes or overlooked steps. If poor coding is a root cause, educating providers will take very little time. If procedure authorization was not obtained, business office staff may need additional training regarding this crucial front-end task.
3. Remittance postings: Are all possible remittances posting electronically? Double check that any recently added new payer Electronic Remittance Advice (ERA) reports have been properly enrolled. Do not waste valuable business office staff time or diminish your days-in-A/R performance by posting remittances manually when reports can be easily be received electronically.
4. Patient portal access: Patients expect web access, including mobile, to directly submit payments to the ASC. The push for this convenience aligns with advancing consumerism-in-healthcare demands and value-based care, saving your staff significant time and reducing your days in A/R. That’s a double win.
5. Patient payment plans: To also reduce days in A/R and make patient payment responsibility collections easier, offer patients payment plans based on their financial capabilities. Many facilities now offer total self-pay patients a discount if balances are promptly paid in full, or even prior to receipt of care. This works well for some services (OB delivery, tonsillectomies, elective plastic surgery). For patients struggling to meet financial obligations of healthcare, offer payment plans with no interest. This saves time for the business office staff and strengthens the patient-provider relationship.
From payer contract review to patient payment plans, these five often-overlooked financial considerations can generate significant additional revenue for providers. If routinely addressed by RCM and business office professionals, they can avoid unnecessary workaround and claims resubmission while cutting staff time for follow-up issue resolution. Each step will also help ASCs better assess their financial health and footing in ever-changing reimbursement programs.
Joncé Smith is the Vice President of Revenue Cycle Management for Stoltenberg Consulting, Inc.