Engulfed in a tumultuous reimbursement landscape, ASCs seek strong partners in revenue cycle management companies. Establishing best practices with these companies proves essential in managing a profitable ASC.
Robert Romero, vice president of business development of Plano, Texas-headquartered MediGain, shared strategies for ASCs to establish strong relationships and maximize outcomes with their revenue cycle management companies. Mr. Romero spoke at Becker's ASC Review 22nd Annual Meeting — The Business and Operations of ASCs.
Workflow management
Transparent communication is essential when establishing a relationship with a revenue cycle company. With a clear understanding of the billing system across the board throughout the ASC, the chance of error declines significantly.
"You want your revenue cycle vendor on your system so that everyone can see the work being done," says Mr. Romero. "Everyone uses the same metrics, the same reporting."
Mr. Romero suggested Smartsheet, a HIPAA-compliant excel worksheet, and eBridge, a scanning solution, as online tools helpful in establishing transparency and real-time communication. Weekly-scheduled phone calls with revenue cycle vendors may also increase efficiency.
Establishing written standard operating procedures will smooth workflow between the two companies. Document acceptable acronyms and protocols, so little confusion arises on either side.
"If you help your revenue cycle management company set up a good template, they should follow the theme every single time," explains Mr. Romero. "They don't have to come to you with everything that happens, only the exceptions to the rules."
Claim submissions, charges & posting
ASCs can ensure proper claim scrubbing by ensuring the involvement of senior billers.
"Having a certified coder in place is one of the things you can do on offense," says Mr. Romero, noting that reviewing physicians' work is crucial to avoiding errors.
Once in the charge stage, an updated fee schedule that is uniform among all providers and surgeons in the ASC will ease the process.
"There should be a lot of synergy across those pathways," says Mr. Romero of clinical pathways. If ASCs don't establish standardization in this stage, it will be a major "dent in offense."
After completing the charge process, posting requires the full utilization of clearinghouse tools. Equipped with a comprehensive list, ASCs will be able to notice if they receive much less than expected from payers.
Accounts receivable
When dealing with AR updates, a "month in time is somewhat of an artificial measure."
Mr. Romero explains a claim should be addressed long before a month expires, suggesting managing AR should occur in about 15 days.
Further, write-offs should never occur unless the ASC fully understands the exact cause of the write-off. Approaching AR management with a code- and payer-breakdown will reveal specific areas of complications.
"The way you get all the money in is to find where you're not getting the little bits of money here and there," says Mr. Romero.
Standard measurements & performance success
MediGain measures performance on the 60th day, and sends any unpaid claims to a senior executive. At that point in time, an unpaid claim must be justified with a reason.
As for measuring success, monthly reports and write-offs require extensive detail. Reimbursement percentage for closed claims should be broken into payer, provider and CPT code.
Mr. Romero showed an example of a "heat chart," which illustrates the average reimbursement for all payers. These charts enable ASCs to see how payers compare for services. He suggests using Medicare as a baseline in order to visualize if a certain payer benefits or thwarts a surgery center.
"That's where you and your revenue cycle vendor come together to decide if your expectation is too high or if your payment is too low," explains Mr. Romero.
ASC systems should already possess the information in a "heat chart," providers just need to display and analyze the data usefully.
Ultimately, Mr. Romero sees success in "know[ing] the payer trends from coast to coast and border to border."