In a shifting payer landscape, ASC administrators need to ensure they're optimizing their reimbursement programs to ensure they're collecting everything they're entitled to.
CollectRx's CEO John Bartos and Revenue Cycle Director Franklin Smith explored current reimbursement trends and shared best practices to improve both in-network and out-of-network claims during an Aug. 6 webinar hosted by Becker's Hospital Review and sponsored by CollectRx.
Reimbursement trends
Patient out-of-pocket spending has risen consistently since 2014, experiencing its most significant increase (8.5 percent) between 2016 and 2017, according to JPMorgan Chase Institute.
As payment responsibility shifts from payers to patients, ASCs have to deal with several new obstacles regarding patient collections.
"[The payer to patient shift] has created numerous obstacles for the delivery of surgical services, including the ability for patients to cover their expenses and surgery centers to collect what is owed to them for performing procedures," Mr. Bartos said.
This shift has led to reduced patient payments. In fact, 66 percent of patients admitted to Transuinon in 2016 that they didn't pay their hospital bill in full. For example, 68 percent of patients did not pay their hospital bills that were $500 or less. Mr. Bartos also referenced a post on Go Practice Blog which noted that patient balances were getting increasingly harder to collect. So what can ASCs do?
10 best practices to maximize payer collections
With patient payment rates dwindling, ASCs need to maximizing payer collections. Mr. Smith shared 10 best practices to do this:
1. Analyze every denied claim, partial payment and nonpayment to recover additional reimbursements
2. Leverage technology to acquire data from payer websites to ensure you can reconcile every account to zero
3. Identify, prioritize and assign at-risk accounts before they are denied, underpaid or delayed
4. Leverage data to uncover root causes of denials, underpayments and delayed payments
5. Review, correct and resubmit denied claims to prevent future delays
6. When a payer re-prices an out-of-network bill, centers need to appeal claims with data
7. Leverage historic payer data when appealing
8. Reconcile first payments, additional payments and patient payments within the original claim
9. Reconcile every account from assignment to zero balance
10. Consider outsourcing components of your accounts receivable process to collections' experts
In turn, ASCs need to develop payer reimbursement programs. Mr. Smith described these programs as "simply the strategy, tools, processes and metrics that ensures you collect the maximum reimbursements from your payers."
Successful payer reimbursement programs are focused on four elements: patient access, billing and coding, payer reimbursement and analytics. When implemented properly, the programs help to improve accounts receivable accuracy, reduce denials and improve collected financials.
Successful programs should optimize every transaction. ASCs leave money on the table when they don't attempt to collect either in-network or out-of-network funds due to them and just accept what the payers give them.
"[Payer reimbursement programs] will allow you to optimize every transaction, and ensure that you are getting the payments you're entitled to from payers," Mr. Bartos said. "It will allow you to maximize cash-to-revenue, decrease collection costs and reduce days outstanding … and perhaps most importantly, it will improve patient experience as the payers become more accountable and meet their obligations."
Mr. Bartos noted that when properly executed, payer reimbursement programs are one of the only ways ASCs can improve financial performance.
To view a recording of this webinar, click here.