Improve ASC Revenue Cycle – Avoid Common Billing Mistakes
Submission of clean claims is crucial for any specialty, including ASCs to get paid promptly. Here are some tips to improve revenue cycle.
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An ambulatory surgical center (ASC) is a healthcare facility that provides medically necessary surgical services to a patient in an outpatient setting. ASCs are paid according to a unique set of regulations and standards under the Medicare program, under Medicaid, and under
contractual
agreements
with
private
commercial
health
insurers.
Diverse
reimbursement challenges related to ASCs can be rectified to a great extent by following standard medical billing and coding practices. Effective management of the revenue cycle, from medical appointment scheduling to payment, by certified, skilled professionals is the single most important factor to positively impact the financial health of an ASC. For on-time reimbursement, efficiency in all areas of the billing process is paramount. Here are certain ways for ASCs to improve their revenue cycle management. Avoid These Medical Billing Mistakes ➢
Lack of Proper Eligibility Verification and Authorization
While scheduling patients, it is a standard practice to gather patient names, insurance, birth date and other pertinent information. But oftentimes this information is not verified, leading to further issues. Insurance eligibility verification helps in preventing denials and avoiding delays in payment. Before the date of the surgery, it is critical to verify personal information and insurance coverage with the payer.
Also, obtain authorizations for the correct
procedure and include implants and costly supplies. Pre-negotiate coverage with adjusters for any uncovered procedures and/or implant(s) and obtain commitments in writing. ➢
Failure to Collect
Financial Responsibility
and Providing Unnecessary
Discounts Routinely waiving or discounting patients’ financial responsibilities will negatively impact the facility’s bottom line, resulting in violation of certain insurance contracts as payers expect providers to collect fees not covered by insurance. The front office should communicate the patient’s financial responsibility prior to the date of service, which helps to collect what is owed to the facility. Payment alternatives can be offered to help patients meet their obligation, but retain copies of any such agreement in the patient chart. ➢
Coding Errors and Incomplete Documentation
Common coding errors include not coding at the highest level, missing implants, not coding bilateral procedures, not using the correct modifiers, unbundling, and not coding for payable
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supplies. Medical coding companies should communicate regularly with surgeons' offices to avoid payer delays due to coding discrepancies between claims. Providers have a responsibility to supply explicit documentation in their operative reports to support all procedures performed. Medical billing and coding specialists should also be provided clarification on several details such as bilateral or multiple procedures, implants used, ancillary services, diagnoses compatible to procedure and specific to contributing factors, specific areas treated and accurate identification of surgical site in order to apply appropriate modifiers. In addition to the latest CPT and ICD-10 reference books, coders can be provided with specialty references that assist in optimizing coding and a product (e.g., book, software) that helps prevent unbundling. ➢
Inaccurate Payment Postings
Payment posting is a crucial part of the medical billing process. Negligible process can result in serious downstream. Daily payment posting and maintaining a current reconciliation are strongly recommended for smooth billing. Explanation of benefits should also be thoroughly reviewed to identify indicators of payment issues or processing errors. The right thing to do is, when payment arrives verify whether payment accurately reflects contract allowance. If payment is denied or if it is incorrect, call the payer to check the real problem and in case no settlement is achieved, start the appeal process. If correct payment is received, after posting payment transfer to secondary insurance or patient guarantor and bill for balance on the same day. ➢
Failure to Monitor the Submitted Claim
It's important to recheck the claim once more before submitting and then obtaining a receipt from the clearing house or payer verifying the claim has been received. Auditing not only ensures compliance with private and government payers' regulations, it also helps to determine whether all of your claims are being processed and paid efficiently. Monthly internal audits of coding and billing and annual external audit by ASC revenue cycle experts are also recommended. Having in place a skilled revenue cycle team can be a challenge for most ASCs. Outsourcing healthcare receivables management to a professional vendor would be a great option. Make sure that the company you choose provides the services of an experienced medical coding
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team that is knowledgeable regarding the differences between various policies and updates to each policy’s requirements. The team must also keep track of the coding changes and updates such as which codes have been deleted or replaced, as payers will reject the claim if you use an outdated code.
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