Here are four ideas to boost revenue cycle management at an ASC.
1. Make it easy for patients to pay. There are several ways surgery centers can make it easy for patients to pay their part, and pay on time, according to Linda Peterson, MBA, CEO of Executive Solutions. She discussed several steps in a webinar hosted with ProVation, with steps including:
• Collect co-pays and deductibles upfront;
• Take credit cards;
• Accept payment plans;
• Contact patients about financial responsibility before the visit;
• Have readily available applications for reduced and free care.
2. Coordinate benefits appropriately. Coordination of benefits is as simple as making sure the patient's primary, secondary and tertiary coverage — if applicable — are loaded correctly into the system, Ryan Flesner, director of A/R, of National Medical Billing Services says. Many patients are unaware of which insurance plan is their primary and which is their secondary, and if you submit the claim to the wrong plan, you will receive an automatic denial.
He says when determining which parents' coverage is the primary, some companies use the spouse with the birthday that falls earliest in the month — a fact that many patients are unaware of. "If mom was born in March and dad was born in February, they're going to go with dad," says Lisa Rock, president of National Medical Billing Services. "[Patients] are absolutely unaware and think they can pick and choose. If dad's has a large deductible and mom has a $20 co-insurance, they think they can choose her plan as the primary, and that's not how it works."
Ms. Rock also warns ASCs to be careful of indicating an injury or illness is related to a motor vehicle accident. "There's a spot on the claim that asks the provider if the injury or illness is related to a motor vehicle accident, and if you mark that box yes and you're billing private insurance, you're going to get a denial," she says. "They're going to want it to go to MVA first or at least want more information, because if it looks like an injury, the private insurance is going to see if someone else is responsible for paying that bill." In MVA cases, mark the claim form correctly and submit to the auto insurance first for any possible PIP benefits, Ms. Rock says. Only submit to the private insurance with a letter of exhaustion.
3. Negotiate payor contracts with the future in mind. Set yourself up for the next contract during current negotiations, says Jim Odom, of The C/N Group. Stay abreast of the ever-changing healthcare industry and know which types of procedures are profitable and how that may change. "If you position product lines you know are going to decline over the course of the current contract, establish a foundation now, so the pain is less when the contract kicks in down the road," says Tom Faith, of The C/N GRoup. Additionally, ask payors about their timeline for switching to the APC reimbursement model. "We've been listening to what they say and how they answer to position ourselves better for the future," says Mr. Odom. "We ask the payor what they are talking about internally for one or two years down the road, such as which procedures are bring pushed into ASCs and which have pressure to be performed at hospitals."
4. Evaluate your payor contracts before adding a new specialty. It's important to evaluate payor contracts before adding a new specialty, like spine, to the surgery center. Spine is a device and implant-intensive specialty and the contracts you have with private payors for general surgery or orthopedics may not be adequate for spine. "Many times, if you are looking to add spine to your center, the representative from the payor might be resistant to allowing changes in the contract to ensure you are fully reimbursed for your expenses," says Dan Beuerlein, regional vice president of operations at Symbion Healthcare. "Many payors will have a maximum amount of what they will pay for a procedure. If your implants and hardware aren't covered as a separate line in the contract, you could find that you're doing those cases at a loss." Surgery centers can spend months negotiating carve-outs for spine surgery or renegotiating existing contracts to get spine cases into the center.
More Articles on Surgery Centers:
Physician Recruitment Timeline: 10 Steps for Bringing a New Physician to Your Surgery Center
How the ASC Industry Can Succeed in the Future: Q&A With ASCOA CEO Luke Lambert
10 States With More Surgery Centers Than Hospitals
1. Make it easy for patients to pay. There are several ways surgery centers can make it easy for patients to pay their part, and pay on time, according to Linda Peterson, MBA, CEO of Executive Solutions. She discussed several steps in a webinar hosted with ProVation, with steps including:
• Collect co-pays and deductibles upfront;
• Take credit cards;
• Accept payment plans;
• Contact patients about financial responsibility before the visit;
• Have readily available applications for reduced and free care.
2. Coordinate benefits appropriately. Coordination of benefits is as simple as making sure the patient's primary, secondary and tertiary coverage — if applicable — are loaded correctly into the system, Ryan Flesner, director of A/R, of National Medical Billing Services says. Many patients are unaware of which insurance plan is their primary and which is their secondary, and if you submit the claim to the wrong plan, you will receive an automatic denial.
He says when determining which parents' coverage is the primary, some companies use the spouse with the birthday that falls earliest in the month — a fact that many patients are unaware of. "If mom was born in March and dad was born in February, they're going to go with dad," says Lisa Rock, president of National Medical Billing Services. "[Patients] are absolutely unaware and think they can pick and choose. If dad's has a large deductible and mom has a $20 co-insurance, they think they can choose her plan as the primary, and that's not how it works."
Ms. Rock also warns ASCs to be careful of indicating an injury or illness is related to a motor vehicle accident. "There's a spot on the claim that asks the provider if the injury or illness is related to a motor vehicle accident, and if you mark that box yes and you're billing private insurance, you're going to get a denial," she says. "They're going to want it to go to MVA first or at least want more information, because if it looks like an injury, the private insurance is going to see if someone else is responsible for paying that bill." In MVA cases, mark the claim form correctly and submit to the auto insurance first for any possible PIP benefits, Ms. Rock says. Only submit to the private insurance with a letter of exhaustion.
3. Negotiate payor contracts with the future in mind. Set yourself up for the next contract during current negotiations, says Jim Odom, of The C/N Group. Stay abreast of the ever-changing healthcare industry and know which types of procedures are profitable and how that may change. "If you position product lines you know are going to decline over the course of the current contract, establish a foundation now, so the pain is less when the contract kicks in down the road," says Tom Faith, of The C/N GRoup. Additionally, ask payors about their timeline for switching to the APC reimbursement model. "We've been listening to what they say and how they answer to position ourselves better for the future," says Mr. Odom. "We ask the payor what they are talking about internally for one or two years down the road, such as which procedures are bring pushed into ASCs and which have pressure to be performed at hospitals."
4. Evaluate your payor contracts before adding a new specialty. It's important to evaluate payor contracts before adding a new specialty, like spine, to the surgery center. Spine is a device and implant-intensive specialty and the contracts you have with private payors for general surgery or orthopedics may not be adequate for spine. "Many times, if you are looking to add spine to your center, the representative from the payor might be resistant to allowing changes in the contract to ensure you are fully reimbursed for your expenses," says Dan Beuerlein, regional vice president of operations at Symbion Healthcare. "Many payors will have a maximum amount of what they will pay for a procedure. If your implants and hardware aren't covered as a separate line in the contract, you could find that you're doing those cases at a loss." Surgery centers can spend months negotiating carve-outs for spine surgery or renegotiating existing contracts to get spine cases into the center.
More Articles on Surgery Centers:
Physician Recruitment Timeline: 10 Steps for Bringing a New Physician to Your Surgery Center
How the ASC Industry Can Succeed in the Future: Q&A With ASCOA CEO Luke Lambert
10 States With More Surgery Centers Than Hospitals