Becker's ASC Review

27 Executive Briefing: Improving ASC A/R Founded in 2009, in2itive Business Solutions is a full-service healthcare revenue management and consultation firm with transparent workflow processes focused on filing claims, uncovering lost revenue and reconciling accounts. The in2itive leadership team represents more than 75 years of collective experience and together they have recovered more than $384 million in revenue for their clients. in2itive offers both long and short-term services, with solutions that include insurance handling, billing services, healthcare coding, reporting and more. 2. Work through old claims and operate on what you know, not how you feel. Start with an aging report, since that will show you what invoices are in process or outstanding, their amount and their number of days in process or past due; subsequently, this is your best in- dicator regarding which accounts need quick attention. You can also use reports like this to track any trends that relate to specific carriers or high-dollar claims. From there, take a look at whether there are any state or payor-specific requirements that may affect a specific geographic area—this can inform whether your claim has failed to comply with those requirements. Once you've determined any relevant trends or facility-specific data, it's time to just do some detail work on the original claim. Review all details associated with the claim and research the path it's taken. Is anything incorrect? Did the claim itself get stuck in the process somewhere and was never finalized? Make any cor- rections that you deem appropriate or necessary, and then resub- mit the claim or, if applicable, file an appeal. Most importantly, make sure to research and find concrete an- swers for every question that arises on a claim—don't assume you know what path the claim took, what error has held it up or why it's been left unpaid. Communicate with the appropriate par- ties, do your due diligence and operate on what you know. 3. Stay determined and keep a keen eye on contract language. As you work through the collections process, you'll eventually want to narrow your focus to those accounts that carry the highest dollar amount; you can really get more bang for your buck when you work this way. Contract language is another important element that requires close attention. Make sure you and your collector are paying keen attention to whether there are details missing or information listed incorrectly and then note whether the error is on multiple claims. In this case, it's in your best interest to contact an insurance rep- resentative and ask for a review process on all claims with the same error. Taking this "short cut" may make it possible for you to process multiple claims at once. Also, just to reiterate an earlier point about filing claims in a timely manner, make sure to check contract language for any details re- garding a "timely filing clause"; this will tell you if a carrier requires that claims be filed within a specified time period. Keep A Step Ahead & You'll Never Fall Behind In most aspects of life, the easiest way to ensure that you never fall behind is to always stay one step ahead. That's exactly what you need to be doing as a medical biller. Laying a simple but sound foundation—one built on the key points laid out for you here—gives you and your business team a platform for ongoing A/R success. Even if your business office is already finding itself a bit behind, the same principles can help you get back out in front. But if the 120+ day stack is burying you, and your team just can't seem to pull ahead, remember that this is a business in which outside help is always available and very often warranted. Consider working with a revenue cycle management company like in2itive Business Solutions; we've helped clients just like you collect more than $384 million in revenue, and we've done it by adhering to the principles we've shared here. Regardless, know that if you're not growing, you're dying, and paid receivables really are the lifeblood of your business. n "In most aspects of life, the easiest way to ensure that you never fall behind is to always stay one step ahead. That's exactly what you need to be doing as a medical biller." — Tracey Erbert, President of in2itive Business Solutions

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