Becker's ASC Review

26 Executive Briefing: Improving ASC A/R 3. Be timely and accurate when filing claims. I recently gave a presentation that included PowerPoint slides. When the time came to discuss filing claims, I shared a slide that included only two things: a picture of Snoop Dogg (who goes by some other name these days) and the phrase "Drop it like it's hot." And that's exactly what you do. Your facility should drop all new claims within 48 hours. Don't be one of those places that waits three or four days—when you're dealing with insurance, money and billing, time is of the essence. If you're committed to dropping all claims within 48 hours, you'll benefit in one of two ways. The first is obvious: the sooner a claim goes out, the sooner your facility can expect payment. On the flip side of that, if your facility is quick to file claims, you'll be more quickly alerted to there being any issues or errors; by filing within 48 hours, you've created a bit of proverbial padding that lets you make any necessary corrections and then resubmit without timely filing risks. Every facility's ultimate goal should be to have all accounts paid within 30 days of the date of service. The only way to ensure that happens is to file claims quickly and accurately. 4. Double check that you're following optimized coding. Coding is a terribly complex aspect of healthcare billing, and it's fur- ther complicated by the fact that there are so many options in how to code and different ideas regarding what's "right." Still, there's plenty your team can do to make sure their coding habits are con- sistent and generate the highest reimbursement for your facility. First thing's first here, and that's just using the highest reimburs- able code. Code modifiers can make a huge difference in this regard and are actually being used more frequently thanks to changes in Medicare regulations; correct use of modifiers will not only ensure maximum reimbursement, it helps guarantee that your facility avoids fraud and non-compliance issues. Beyond thorough knowledge of the coding system, facilities can help keep themselves in check by scheduling routine audits at least once a year. in2itive's suggestion is that you set a compli- ance goal before every planned audit and then evaluate your in- tended performance against your actual—the variances will help you determine whether anything is off (and if so, what). A last word on coding tends to be the most difficult for people to hear: be open to alternate ideas. The challenging part of coding is that it's not black and white and there's always room for discrep- ancy. Coders are generally wise to take an outside perspective seriously when it comes to evaluating their coding performance; one person may catch a glaring error in what somebody else has spent too much time staring at. 5. Follow up in a timely manner and just communicate clearly. Everyone knows that communication is key, but it's only effective if it's timely and targeted. One of the biggest shortcomings in billing communications con- cerns billers communicating with surgeons or those performing a procedure. The truth is, only those in the OR or procedure room know what was done, what was used and what you should be bill- ing. Always communicate with your facility's surgeons and physi- cians to ensure that what's being described in your bill or claim is an honest reflection of what was done. Beyond the clinical staff, make sure that all parts of your team are communicating with each other. Medical billing and A/R man- agement requires a lot of moving parts—keep every one of them aligned and in check. Managing the Future: Mind the 120+ Day Bucket That brings us to overdue accounts. The 120+ day bucket is a topic all its own, and it's one that every hospital and ASC has to master in order to be consistently successful and ahead of bad debt. But don't think that a balance older than 120 days is "bad debt"—it's just a debt you haven't collected yet. Keep a cleaner A/R, and a more robust bottom line, with these three tips on collecting overdue balances. 1. Investigate everything that's out of date. Outdated balances generally suggest that there's something wrong with the claim that was filed. It's your job to find out what. Was it human error that can be identified and corrected for the fu- ture? Did a mailing become lost somewhere along the line, maybe because of an incorrect patient address? Generally speaking, it's in your best interest to hand investigative efforts over to an experienced collector who has the patience and experience to know where to go for answers, who understands the billing cycle start to finish and who has the perseverance to go through more paper stacks than most of us would ever consider reasonable. Some may try to convince you that an account is not worth the involvement of a collections agency, but the truth is, your facility cannot afford to offer free service and your billing team can't af- ford to spend all their time working overdue accounts; collections groups have a purpose and a place and your facility could be well served by employing such a service. Bear this in mind: Even if you have to pay someone 50% of the collections, 50% is better than nothing—don't write these things off. in2itive Business Solutions has a 99% receivable average, and plenty of what's been brought to us has been overdue and outdated accounts. We know nothing is over until it's over, and we know that the majority of accounts can always be settled. "Your facility should drop all new claims within 48 hours. Don't be one of those places that waits three or four days—when you're dealing with insurance, money and billing, time is of the essence." — Tracey Erbert, President of in2itive Business Solutions

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