Things to Consider When Reviewing Ambulatory Surgery Center Billing and Lag Day Conflicts
When you review the billing of an Ambulatory Surgery Center, you as a practicing physician need to understand that there are many things to consider, in order to streamline the entire workflow. However, with rising healthcare costs, claims being denied or delayed and increasing scrutiny of medical billing and coding procedures by the insurance providers an ASC needs to get their act right, before you face negative revenue numbers. Points to remember 1) Are there unbilled charges from over a month back?
2) What number denials appear in the EOBs acquired from Medicare and for the past week? Most ASCs tend to review all the EOBs.
3) What's the correlation of new patients to existing patients over the past years? What sorts of insurance policy coverage do they represent?
4) How does the Accounts Receivable Master look? What number of high-dollar claims (e.g. above $1,000) are untouched – more than 90 days, 120 days and much more?
5) When was the last time the contracts were updated?
There are a few different things that one could search for and do, however on the outset one needs to realize how the facility is doing. Answering the five points above usually provides you with a direction to probe more. Most ASCs supplement the above mentioned points for interviews with staff. Another important activity that many facilities follow is to simply sit at the front desk and observe patient flow and work flow throughout the day, sometimes for several minutes at a stretch.
Minimizing Charge Entry Lags Running a fruitful mobile Ambulatory Surgery Center frequently includes crunching and ascertaining consistent stream numbers, volume and dollars in AR, payment comparison, operating expenses and so forth. Streamlined revenue and billing cycle will result in a regulated reimbursement cycle. But, one of the most basic and neglected aspects of the billing charge entry lag days. Keep in mind that the delay between the date of service and actual claims submission is the lag period, and these very lag days lead to an uncertain revenue cycle.
Issues that crop up with an uncertain revenue cycle
1. Income prediction becomes difficult.
2. The Revenue/Income cycle is never standard.
3. Identifying problematic areas remain strenuous.
Handling the charge entry lag days
In a perfect scenario, all claims must be submitted close to the time of care and well inside 24 hours of the date of administration. If this isn't going on, there are just two possible situations: either doctors are finishing their charts/reports too late to trigger charge entry or the billing department is not confirming charges or entering them in time. If this problem continues to grow, you can use the services of specialty medical billers and coders to finish the job for you, with any lag days.
Here are six swift tips to limit lag days:
1. Try to finish the first encounter documentation while you see patients. For consultations, enter the counsel and diagnosis codes amid or not long after the visit. For procedures, try to finish all encounter documentation instantly or before the end of day.
2. Make ideal utilization of technological platforms. Put resources into EHR/practice management software that incorporates billing modules, ideally a versatile arrangement which can help you finish billing on the go.
3. Personalize the encounter sheet or EHR modules to coordinate your style of work and limit the time spent.
4. Automate the revenue and billing cycle wherever possible. Utilize OCR programming to separate relevant text from examined encounter sheets and couple it with custom automation scripts to report CPT and ICD codes inside an EHR/PMS. Build up benchmarks for your practice or Ambulatory Surgery Center regarding the acceptable lag to submit claims. Keep up and track the lag days report and persistently work on proficiency.