A recent webinar, "Maximizing Reimbursement for ASCs," discussed how surgery centers can improve revenue cycle processes to achieve appropriate reimbursement. The presenter, Caryl Serbin of SourceMedical Revenue Cycle Solutions, discussed each step of the revenue cycle process and shared tips for accurate, timely claims submission and payment collection.
Ms. Serbin began the webinar by explaining that the most successful surgery centers handle their revenue cycle through an organized, consistent routine of tasks. "When I see centers that are having constant special projects, that's a red flag for me," she says. She says revenue cycle processes should verge on "boring" because they are so expected and systematic.
Common problems affecting surgery center revenue cycles
Ms. Serbin says there are several common problem areas in the ASC revenue cycle, including:
1. Finding sufficient and experienced staff.
2. Lack of appropriate follow-up on claims, denials and appeals..
3. Implant reimbursement vs. implant cost.
4. Not appealing to the highest available level.
5. Not knowing and following managed care billing policies.
6. Unfavorable A/R trends.
Improving the revenue cycle process: Before billing
To improve the revenue cycle process in a surgery center, billing teams must start with the pre-operative process, Ms. Serbin says. The most important tip regarding scheduling is to get the best information possible from the physician office, Ms. Serbin says.
Registration involves "complete and accurate data entry," she says. Medicare's number two reason for claim denials is incomplete or invalid information, so make sure your information is correct up-front. Check the spelling of the patient name, social security number, date of birth and other simple but common mistakes. For insurance verification, Ms. Serbin likes to use a good, thorough insurance verification form that keeps staff on task and consistent.
Before surgery, billing teams should talk to the patient to re-verify demographic and insurance information, then advise the patient of the ASC's financial policies. To make it easy for patients to pay, explain the various payment methods you accept, including cash/check/credit card, healthcare credit companies, automatic monthly debits of checking account or promissory note, if applicable.
Improving the revenue cycle process: Starting the reimbursement process
Operative notes must be dictated quickly to speed up the reimbursement process, Ms. Serbin says, and physicians should be educated on the necessary information to obtain optimum reimbursement. "Accuracy and completeness of operative notes is essential," Ms. Serbin says. "If it's not documented, it didn't happen."
She says transcription should not be a problem for surgery centers if they find a good transcription company and include performance criteria in the contract. "Clean claims pay themselves," Ms. Serbin says, so make sure your coders are entering the right information the first time around. Coders should also receive implant information in a timely manner and must have access to up-to-date reference materials.
Ms. Serbin adds that accurate charge posting is the "first line of defense against denials." In order to improve charge posting accuracy, posters should be familiar with different payor contracts and have a good, consistent knowledge of CPT-4/diagnosis codes and modifiers.
Improving the revenue cycle process: Collecting from patients
Ms. Serbin recommends ASCs establish an effective self-pay policy to maximize self-pay collections and then monitor collections to determine whether patients are actually paying. Surgery centers should establish a small balance write-off policy so they don't spend more collecting than they stand to collect.
The first patient statement should be sent immediately after the correct insurance payment is received, and the ASC should send two statements, give a courtesy phone call and a final notice before submitting the patient to a collection agency. If a patient is using a payment plan, billing team members should follow up regularly to ensure compliance.
Improving the revenue cycle process: Payment posting
Payment posters are the surgery center's first line of defense against erroneous reimbursement, Ms. Serbin says. If the payment is correct, the poster can post the payment and then reassign the balance to an appropriate responsible party. If the payment is not what the ASC expected, the poster should determine the specific reason for the difference, review the coding for accuracy and call the payor to question the discrepancy.
If your surgery center needs to file an appeal, first make sure that the payment deficiency did not occur because of a billing or coding error on your end, Ms. Serbin says. Then review payor requirements to file a denial, use payor forms if necessary and include all attachments when sending to the payor.
Improving the revenue cycle process: Monitor A/R and performing audits
Industry benchmarks are helpful up to a point when monitoring A/R, Ms. Serbin says. While surgery centers should keep an eye on industry benchmarks, they should also develop center-specific benchmarks that include a combination of total A/R, A/R by payor, aging of A/R, days in A/R and patient portion of A/R.
She says internal process audits should be conducted regularly to check for accuracy and timeliness of coding, claims processing, payment posting and collections.
Download the Webinar presentation by clicking here (pdf).
Hear more webinars from Caryl Serbin:
• Meeting Today's Reimbursement Challenges: A Case Study for Success (click to view or download this webinar)
• Case Study: Improving ASC Billing and Collections (view the PowerPoint presentation of this webinar)
Learn more about SourceMedical.
Ms. Serbin began the webinar by explaining that the most successful surgery centers handle their revenue cycle through an organized, consistent routine of tasks. "When I see centers that are having constant special projects, that's a red flag for me," she says. She says revenue cycle processes should verge on "boring" because they are so expected and systematic.
Common problems affecting surgery center revenue cycles
Ms. Serbin says there are several common problem areas in the ASC revenue cycle, including:
1. Finding sufficient and experienced staff.
2. Lack of appropriate follow-up on claims, denials and appeals..
3. Implant reimbursement vs. implant cost.
4. Not appealing to the highest available level.
5. Not knowing and following managed care billing policies.
6. Unfavorable A/R trends.
Improving the revenue cycle process: Before billing
To improve the revenue cycle process in a surgery center, billing teams must start with the pre-operative process, Ms. Serbin says. The most important tip regarding scheduling is to get the best information possible from the physician office, Ms. Serbin says.
Registration involves "complete and accurate data entry," she says. Medicare's number two reason for claim denials is incomplete or invalid information, so make sure your information is correct up-front. Check the spelling of the patient name, social security number, date of birth and other simple but common mistakes. For insurance verification, Ms. Serbin likes to use a good, thorough insurance verification form that keeps staff on task and consistent.
Before surgery, billing teams should talk to the patient to re-verify demographic and insurance information, then advise the patient of the ASC's financial policies. To make it easy for patients to pay, explain the various payment methods you accept, including cash/check/credit card, healthcare credit companies, automatic monthly debits of checking account or promissory note, if applicable.
Improving the revenue cycle process: Starting the reimbursement process
Operative notes must be dictated quickly to speed up the reimbursement process, Ms. Serbin says, and physicians should be educated on the necessary information to obtain optimum reimbursement. "Accuracy and completeness of operative notes is essential," Ms. Serbin says. "If it's not documented, it didn't happen."
She says transcription should not be a problem for surgery centers if they find a good transcription company and include performance criteria in the contract. "Clean claims pay themselves," Ms. Serbin says, so make sure your coders are entering the right information the first time around. Coders should also receive implant information in a timely manner and must have access to up-to-date reference materials.
Ms. Serbin adds that accurate charge posting is the "first line of defense against denials." In order to improve charge posting accuracy, posters should be familiar with different payor contracts and have a good, consistent knowledge of CPT-4/diagnosis codes and modifiers.
Improving the revenue cycle process: Collecting from patients
Ms. Serbin recommends ASCs establish an effective self-pay policy to maximize self-pay collections and then monitor collections to determine whether patients are actually paying. Surgery centers should establish a small balance write-off policy so they don't spend more collecting than they stand to collect.
The first patient statement should be sent immediately after the correct insurance payment is received, and the ASC should send two statements, give a courtesy phone call and a final notice before submitting the patient to a collection agency. If a patient is using a payment plan, billing team members should follow up regularly to ensure compliance.
Improving the revenue cycle process: Payment posting
Payment posters are the surgery center's first line of defense against erroneous reimbursement, Ms. Serbin says. If the payment is correct, the poster can post the payment and then reassign the balance to an appropriate responsible party. If the payment is not what the ASC expected, the poster should determine the specific reason for the difference, review the coding for accuracy and call the payor to question the discrepancy.
If your surgery center needs to file an appeal, first make sure that the payment deficiency did not occur because of a billing or coding error on your end, Ms. Serbin says. Then review payor requirements to file a denial, use payor forms if necessary and include all attachments when sending to the payor.
Improving the revenue cycle process: Monitor A/R and performing audits
Industry benchmarks are helpful up to a point when monitoring A/R, Ms. Serbin says. While surgery centers should keep an eye on industry benchmarks, they should also develop center-specific benchmarks that include a combination of total A/R, A/R by payor, aging of A/R, days in A/R and patient portion of A/R.
She says internal process audits should be conducted regularly to check for accuracy and timeliness of coding, claims processing, payment posting and collections.
Download the Webinar presentation by clicking here (pdf).
Hear more webinars from Caryl Serbin:
• Meeting Today's Reimbursement Challenges: A Case Study for Success (click to view or download this webinar)
• Case Study: Improving ASC Billing and Collections (view the PowerPoint presentation of this webinar)
Learn more about SourceMedical.