At the 18th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 27, Kim Woodruff, vice president of corporate finance and compliance at Pinnacle III, presented seven outsourcing options for ASCs.
1. Secure payor contracts that address your facility's case mix. For new ASCs, developing contracts with payors can take 9-12 months, according to Ms. Woodruff. She said ASCs that don't have the time or expertise for this task should consider outsourcing it.
2. Authorize the service, verify the benefits and accurately enter patient demographics. Ms. Woodruff said the most common cause of claim rejections is patient verification and/or registration errors. Outsourcing this process may help reduce these errors and prevent claim rejections.
3. Coding services and entering applicable charges. ASCs need a certified coder who can discuss potential errors in codes with physicians, Ms. Woodruff said. Correct coding is essential for remaining compliant and avoiding fraud. Furthermore, the new coding set ICD-10 will begin in two years and will include higher specificity.
4. Claims transmission. Sending claims requires monitoring claims transmissions reports, addressing errors and establishing a working relationship with the clearinghouse.
5. Post payments by line item. ASCs should load contracts into their patient accounting system and ensure the account balances reflect anticipated net receivables, Ms. Woodruff said. Developing a relationship with payors can also help ASCs resolve errors in their systems.
6. Track denials. ASCs can determine the root cause of recurring issues by tracking and trending denials. Outsourcing this process can reduce the time required to collect the data.
7. Patient collections and bad debt management. Ms. Woodruff said ASCs should avoid focusing only on high payments because patients will return, and those that pay their bills will be valuable.
Ms. Woodruff said outsourcing these processes can help ASCs overcome the challenge of finding and retaining qualified personnel and maintain workflow when in-house employees are ill or on vacation. However, one process that ASCs must do in-house is collecting co-pays and deductibles at the time of service, according to Ms. Woodruff. "Be comfortable with having payment conversations with patients," she said.
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1. Secure payor contracts that address your facility's case mix. For new ASCs, developing contracts with payors can take 9-12 months, according to Ms. Woodruff. She said ASCs that don't have the time or expertise for this task should consider outsourcing it.
2. Authorize the service, verify the benefits and accurately enter patient demographics. Ms. Woodruff said the most common cause of claim rejections is patient verification and/or registration errors. Outsourcing this process may help reduce these errors and prevent claim rejections.
3. Coding services and entering applicable charges. ASCs need a certified coder who can discuss potential errors in codes with physicians, Ms. Woodruff said. Correct coding is essential for remaining compliant and avoiding fraud. Furthermore, the new coding set ICD-10 will begin in two years and will include higher specificity.
4. Claims transmission. Sending claims requires monitoring claims transmissions reports, addressing errors and establishing a working relationship with the clearinghouse.
5. Post payments by line item. ASCs should load contracts into their patient accounting system and ensure the account balances reflect anticipated net receivables, Ms. Woodruff said. Developing a relationship with payors can also help ASCs resolve errors in their systems.
6. Track denials. ASCs can determine the root cause of recurring issues by tracking and trending denials. Outsourcing this process can reduce the time required to collect the data.
7. Patient collections and bad debt management. Ms. Woodruff said ASCs should avoid focusing only on high payments because patients will return, and those that pay their bills will be valuable.
Ms. Woodruff said outsourcing these processes can help ASCs overcome the challenge of finding and retaining qualified personnel and maintain workflow when in-house employees are ill or on vacation. However, one process that ASCs must do in-house is collecting co-pays and deductibles at the time of service, according to Ms. Woodruff. "Be comfortable with having payment conversations with patients," she said.
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