At the Becker's ASC 21st Annual Meeting in Chicago on Oct. 23, two professionals from In2itive Business Solutions discussed seven key steps to turning around an underperforming ambulatory surgery center.
For those ASC administrators striving to improve cash flow and their center's bottom line, Tracey Erbert, president and CEO, and Jocelyn Gaddie, vice president of business development, recommended they hone in on revenue cycle management. More specifically, they detailed seven steps administrators can take to improve performance in this area.
1. Verify, every single time. Verify insurance coverage prior to time of service. Administrators should set expectations for when verification should be completed, whether two weeks or three to five days out. "Don't assume that just because the patient was eligible for benefits for that procedure that they will be eligible next week," said Ms. Erbert.
2. Collect payments at time of service. Don't chase payments on the backend. By collecting payments at time of service, administrators can reduce collection costs, lessen bad debt and avoid last-minute cancellations. It costs between $8 and $12 for each statement sent out to patients, noted Ms. Gaddie. That figure might seem small, but take into account how many patients you are sending statements to, and that money can quickly add up.
3. Code within 24 hours. If dictation isn't happening, talk to the physicians. If a physician doesn't dictate for a few days, that creates a pattern and delays coding. Ms. Erbert and Ms. Gaddie said they once had a case where an ASC was short $240,000 net because a surgeon hadn't dictated in a month. Further, administrators should hire coders with an eye for detail who verify all medical records and properly use modifiers. This is especially crucial in light of the pending transition from ICD-9 to ICD-10.
4. Enter charges and file claim within 24 hours. Work denials within 72 hours. Track and trend denials, and discuss them regularly with the biller.
5. Follow up on unpaid claims after 21 days. "We see this all the time," said Ms. Gaddie. "We have three collectors, but are they collecting? If they're not on the phone with those patients, where is money coming in?" Administrators may benefit from setting expectations at their center, such as collectors touching 40 accounts per day. It's also important to monitor them to ensure the collector is taking action steps rather than refiling claims day after day, said Ms. Erbert.
6. Look after the 120+ day bucket. Make sure you have action plan in place to clean up outstanding claims that are more than 120 days old. If staff can't manage it, consider outsourcing this. There is possibly some money to collect.
7. "Drop it like it's hot." You want to ensure your business office is getting clean claims out the door as quickly as possible. In other words, drop them as soon as possible. It's also a good idea to cross-train employees for greater flexibility and efficiency. This way, when there is some down time, employees can help post bills and keep accounts payable in order.