Becker's ASC Review

36 Coding & Billing Finally, while it is worthwhile to focus on A/R days, ASCs must also focus on cash collections. Low A/R days but poor cash collections can have the same negative impact on a facility as high A/R days. Q: How can ASCs ensure they receive pay- ments from patients efficiently, especially with high-deductible plans on the rise? Jn: It is critical to educate patients on their finan- cial responsibilities prior to their day of surgery. Once an ASC receives patient insurance informa- tion, it must work to determine what the patient's responsibility will be. While it sometimes can be difficult to pinpoint this exact figure until the procedure is completed, providing patients with a good estimate well in advance — preferably at least several days before their procedure — will give them ample time to ensure they have the funding to cover costs. It is best to provide patients with as many pay- ment options as possible, including cash, credit card or a payment plan. Payment — as much of it as possible — should be collected prior to sur- gery as the moment the patient leaves the ASC without paying, the likelihood of collecting de- creases as the work needed to now collect pay- ment increases. ASCs should make sure staff is trained to ex- plain how deductibles, co-pays and co-insurance works, why they're important for patients to pay, discuss payment options and know how to work with patients who are concerned about the cost of their procedure. The more patients understand their responsibil- ity and the more time they have to account for it, the more likely it is that they will show up on the day of surgery prepared to cover their portion. A friendly, compassionate staff that understands and strives to find a financial solution that works well for both the ASC and the patient can go a long way as well. n H ere are the top 10 procedures performed at ambulatory care facili- ties by total billed amounts from Nov. 15, 2012 to Feb. 11, 2013, and the denial rates for each procedure based on data collected by RemitDATA, an independent source of comparative analytics for reimburse- ment, utilization and productivity data. The database houses 25 percent of all national outpatient remits. 1. Proton treatment simple with comp.: 10 percent 2. Proton treatment intermediate: 10 percent 3. Cataract Surgery With IOL 1 Stage: 7 percent 4. Upper GI/Endoscopy Biopsy: 8 percent 5. Provide INR Test Mater/Equipment: 10 percent 6. Stereoscopic X-Ray Guidance: 6 percent 7. Office/Outpatient Visit, Est. (CPT 99214): 9 percent 8. Office/Outpatient Visit, Est. (CT 99213): 7 percent 9. Radiation Tx Delivery Intensity Modulated Radiation Therapy: 14 Percent 10. Colonoscopy and Biopsy: 9 percent Here are the top 10 reasons why the most commonly billed procedures in am- bulatory surgical facilities were unexpectedly denied based on data collected between Nov. 5, 2012 and Feb. 11 2013 by RemitDATA. 11. Claims or service lacks information which is needed for adjudication. 12. Duplicate claim or service. 13. Procedure or treatment is deemed experimental or investigational by the payer. 14. The benefit for this service is not included in the payment or allowance for another service or procedure that has already been adjudicated. 15. These are non-covered services because they are not deemed "medically necessary" by the payer. 16. Pre-certification, authorization or notification is absent. 17. Claims were not covered by the payer or contractor. You must send the claim to the correct payer or contractor. 18. Payment for the claim or service may have been provided in a previous payment. 19. The patient or insured health identification number and name do not match. 20. Coverage or program guidelines were not met or were exceeded. Here are the top 15 states with the worst denials rates for ambulatory sur- gery centers based on information from the top 10 ambulatory surgery center codes for unexpected denials, according to RemitDATA. 21. New York — 37 percent 22. Georgia — 27 percent 23. Kentucky — 22 percent 24. Kansas — 21 percent 25. Indiana — 19 percent 26. South Carolina — 17 percent 27. Minnesota — 16 percent 28. Pennsylvania — 15 percent 29. Washington — 12 percent 30. Illinois — 11 percent 31. Maryland — 10 percent 32. New Mexico — 10 percent 33. Virginia — 9 percent 34. Delaware — 8 percent 35. Alabama — 8 percent n 35 Statistics on ASC Claim Denials By Laura Miller

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