Becker's ASC Review

Executive Briefing: 48 Executive Briefing Sponsored by: C oding, billing and collections represent the foundation for a successful ASC revenue cycle. But the key word is "foundation." While coding, billing and collections play critical roles in achieving revenue cycle success, they are not performed in a vacuum. Rather, there are many other functions essential to securing timely and accurate payments. The complete ASC revenue cycle is comprised of the following functions: • Insurance verification and authorization • Dictation • Transcription • Coding • Charge entry • Claim submission, including any secondary and tertiary billing • Collections, including follow-up • Payment posting • Patient billing The interdependence of these functions — and the various elements that further comprise them — means that if the importance of just one of them is slightly discounted or misunderstood, financial performance can suffer, and other challenges may develop. Every function must thrive individually and collectively. When they all perform well together, the overall revenue cycle management process accelerates. Here are five of the most frequently overlooked elements of revenue cycle functions and guidance to help your ASC achieve a thriving revenue cycle. 1. Eligibility, verification and authorization There are few elements that can more significantly disrupt an efficient collections process than documenting inaccurate patient insurance information. When ASCs do not identify such discrepancies, billers may submit claims to an incorrect payer or attempt to bill for a procedure that may no longer be covered. Such errors can lead to denials, delays in payment, no payment, and other billing headaches. Recommendations: ASCs must ensure eligibility, benefits verification and proper authorizations are performed consistently. Insurance details should never be assumed, even for patients coming for recurring or multiple procedures. Technology is available that allows staff to verify insurance information and determine coverage. Such solutions can often estimate a patient's financial responsibility, helping improve upfront collections. 2. Days to dictate Considered an essential revenue cycle key performance indicator ASCs should track, understanding number of days to dictate helps determine whether providers are completing their dictation in a timely manner. Any completion delays will then stall completion of the functions that follow. If dictation delays become significant, an ASC can risk losing payment. Recommendations: If you observe an increase in days to dictate, act fast. Speak with the responsible provider about what they require for timelier dictation. Consider investing in solutions that can help expedite dictation and transcription. These include mobile apps that providers can use to dictate and complete operative reports. 3. Inaccurate and incomplete operative notes When an operative note includes inaccurate or incomplete billable information and the coder fails to catch the discrepancy, incorrect coding will likely occur. If a payer detects the mistake, it will issue a denial, forcing an ASC to allocate resources to correct and resubmit the claim. ASCs can face serious consequences if incorrect coding occurs frequently. Recommendations: To reduce the likelihood of inaccurate or incomplete operative notes, ASCs should supply physicians with the aforementioned technology and provide education about the information required for complete operative notes, possibly as part of a clinical documentation improvement program. Additionally, ASCs should ensure their coders, billers or coding company can recognize poor documentation. 4. Payer-specific billing rules While billing rules sometimes overlap between payers, there are typically substantial differences that must be understood to submit clean claims. Rules compliance can become more complicated when a procedure(s) requires secondary and tertiary billing. When billers do not understand and consistently follow their payers' billing rules, this typically leads to denials. Recommendations: To avoid billing errors associated with payer-specific rules, ASCs must employ or contract with billers possessing ASC-specific billing expertise, including billing multiple payer types and insurance plans. ASCs must also ensure these billers can remain current on payer rule changes. If a rule change occurs that affects an ASC's procedure and/or specialty and a biller is unaware of the revision, surprising denials are likely to follow or the ASC may miss out on new billing opportunities. 5. Other KPIs Days to dictate is not the only overlooked revenue cycle KPI ASCs should track. ASCs should monitor accounts receivable The impact of overlooking key elements of the ASC revenue cycle By Angela Mattioda, Vice President of Revenue Cycle Management Services, Surgical Notes

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