Revenue cycle management is increasingly important for ambulatory surgery centers to maintain a profitable bottom line. Even efficient centers today can do more to save money and improve collections. Vice President of Revenue Cycle Management at Meridian Surgical Partners April Sackos discusses how to overcome the biggest challenges in ASC revenue cycle management.
Internal audits
In addition to conducting a third party coding audit annually, conducting internal revenue cycle audits will keep ASCs on the right track and revenue cycle managers focused on key performance areas.
"I recommend performing monthly revenue cycle audits," says Ms. Sackos. “The initial audit should include every open account with monthly spot checks thereafter. The audit process should follow the account from beginning to end. Look at each phase of the revenue cycle process and correct deficiencies.”
Once you have established a baseline, you can benchmark against prior months or industry standards. Develop policies and procedures for revenue cycle efficiencies and keep staff accountable for following them.
Upfront collections
Consistent upfront collections are important. Benefit verification should be timely and the patient should be notified of their estimated responsibility ahead of time. Develop payment plan guidelines and train staff members on discussing financial matters with patients.
"Staff can be apprehensive when it comes to discussing financial matters with patients. With the shift in healthcare towards higher deductible health insurance plans, it is critical that they have a comfort level having these discussions," says Ms. Sackos.
“A great way to improve collections is to implement online payment options for patients. It is an excellent way to make the up-front collections process easy for staff and patients. Customized parameters are available for ASCs to create online patient payment plans as well.
"While not everyone prefers to pay their bill online; there are a growing percentage of patients who want this option. Having an online payment option in place makes it easy for ASCs to collect from the patients who prefer to pay electronically."
Common front-end errors that could lead to claims denials include:
• Demographic errors
• Lack of prior authorization
• Lack of knowledge regarding payer specific billing guidelines
• Billing keying errors
Back end collections
Back-end errors leading to claims denials are often payer-related and could warrant a call to your provider representative. Coding-related errors may warrant a coding audit to improve this process.
A/R and follow-up
Many ASC collectors choose high dollar accounts when working the A/R, but if they're not following up on all the other claims they're leaving a significant amount of money uncollected.
"Every account needs to be monitored," says Ms. Sackos. "Have firm guidelines and make sure staff are noting their follow up activity. You should be conducting regular staff meetings to review revenue cycle processes and monthly goals."
Claims should be entered and generated within 48 hours, says Ms. Sackos. "Just because charge entry has occurred does not mean claims were generated and submitted for processing. Pay attention to both processes and also verify that EDI reports do not reflect rejections."
Initial A/R follow-up should occur within 15 days from the date of claim submission with additional follow-up every seven to 14 days, depending on the payer. "Technology can help automate this process, but it is also important to speak to a representative if the claim has not been processed in a timely manner," says Ms. Sackos. "It is important to understand your payer contracts. There should always be detailed follow-up notes in the patient accounting system."
Avoid big mistakes
The biggest mistakes Ms. Sackos sees in ASC billing process management include:
• Staff not adhering to the policy and procedures
• Lack of upfront collections
• Lack of clean claim submissions
• Lack of timely filing of claims
• Inconsistent follow-up
You need have proper staffing in place for the revenue cycle to be effectively maintained. Facility volume and payer mix, will determine staffing needs.
“Staffing needs for a high Medicare volume facility, submitting primarily electronic claims, will be significantly different compared to a facility performing higher acuity cases such as orthopedic or spine,” says Ms. Sackos.
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