Becker's ASC Review

46 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine - call (800) 417-2035 W hen it comes to billing, if you are not measuring it, you are not managing it. The key to an effective billing process, and higher revenues, is generating data, accurately analyzing that data, and following through on outstanding claims. Sounds simple? In theory, yes, however for many busy ambulatory surgery centers managing billing pro- cesses is a constant struggle and the reason for lost revenues. To help facilities get a better handle on billing as we kick off a new year, con- sider the following tips for effectively managing billing processes. 1. Don't overlook scheduling. Scheduling is a critical piece of the billing process from both a patient flow and billing perspective. Scheduling conflicts can lead to canceled procedures, which translate to lost revenues. In the event a scheduler fails to confirm the availability of key resources (i.e., a piece of ma- chinery for a specific procedure) additional revenue is lost as operating rooms are left sitting idle due to last-minute cancellations. Fortunately, technology exists that enables facilities to automate the schedul- ing process; some systems even allow information sharing between a physi- cian's office and the facility. 2. Conduct insurance verification ahead of time. Verifying a pa- tient's coverage, including any authorizations or pre-certifications, well in advance of a procedure will help facilities avoid needless billing delays. Auto- M ichael Orseno, revenue cycle director at Regent Surgical Health, identifies four common areas that translate into lost income and the policies ambulatory surgery center leaders can put in place to overcome these revenue cycle issues. 1. Insurance verification. Insurance verification is a simple process, but when overlooked it translates into lost revenue. If insurance is not verified, ASCs may lose money on uninsured patients or those who recently lost their benefits. "At Regent centers, 100 percent of cases need to go through the insurance verification process. This has alleviated past issues of performing cases for free," says Mr. Orseno. A policy for regular insurance verification is easily implemented. With software, such as HST Path- ways and ZirMed, verification can be instantly ob- tained and viewed in a patient's chart. ASC leaders are able to see a whether a patient's insurance is active, their co-pay, co-insurance, deductible and remaining deductible. Pre-operative authoriza- tions still require manual staff time, but the entire process serves as a way to prevent lost revenue. 2. Scheduling. Proper scheduling is key to ASC efficiency and operational success. But, schedul- ing is not only about maximizing operating room time. The types of cases scheduled are equally important. Effective schedulers will have a grasp how profitable cases are based on case cost and payer reimbursement. "Perform case costing and know your margins," says Mr. Orseno. Scheduling is of particular importance in centers that rely on a high volume of out-of-network cas- es. "In out-of-network facilities you want to avoid scheduling cases with patients that have a high out-of-network deductible or no out-of-network benefits," says Mr. Orseno. Insurance verifica- tion is the first step in understanding which cases make sense to schedule and which do not. As a number of ASCs begin to take on higher acu- ity cases, such as joint replacement, the implant price becomes an important consideration dur- ing scheduling. A single implant can cost $20,000. Perform a return on investment analysis and deter- mine whether or not reimbursement for the pro- cedure will cover its costs. Consider implementing a protocol requiring administrator approval before scheduling a high-price implant case. 3. insurance follow-up. Thorough follow-up ensures ASCs capture as many dollars as possible for the cases performed. "Know your contracts and don't accept anything less than what you are contractually owed," says Mr. Orseno. In the case of out-of-network centers, payers will often at- tempt to settle for 20 percent or less of a proce- dure's gross charges. Policies need to be put in place to verify that the cen- ter is receiving maximum reimbursement. If a payer is not meeting contractual levels, appeal the under- payment immediately. In out-of-network centers, create a threshold for reimbursement and if that threshold is not met, escalate the issue with payers. 4. Patient collections. Rising patient deduct- ibles and out-of-pocket costs are a well-known issue in healthcare. ASCs will lose money un- less they make an effort to discuss this fact with patients prior to the procedure. "The chance of collection drops 50 percent after the procedure is done and it continues to drop every 30 days with- out payment," says Mr. Orseno. After insurance has been verified, ASC leaders can sketch an estimate of what a patient's finan- cial responsibility will be based on the deduct- ible and co-insurance. Review a patient's benefits with them and explain the cost. Determine a set amount that is due before the procedure and ex- plain payment options for any amount remaining after the payer has adjudicated the claim. Open communication prepares patients for their finan- cial responsibility and mitigates the risk of ASCs losing on collections. n 7 Tips for Effectively Managing ASC Billing Processes By Heather Keidel Hayes, CASC, Director of Client Services for SourceMedical Overcome the 4 Most Common Pitfalls in ASC Revenue Cycle By Carrie Pallardy Michael Orseno

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