Becker's ASC Review

21 Executive Briefing scrutinizing claims more closely, it is important that the busi- ness office team has experience working such claims. Many OON carriers will make a low initial payment followed by a larger percentage of payment during the appeal process. 7. Failure to monitor key performance metrics. To identify revenue cycle problems early and enact lasting improvements, ASCs must monitor and benchmark key performance metrics. Without measurable, actionable data provided by strong busi- ness intelligence capabilities, it is substantially more difficult to determine and correct the root cause of revenue cycle prob- lems in a timely manner. Examples of reimbursement delays identified by insights into the revenue cycle include: • Charge Lag Over 5 Days: If the facility's charge lag is over five days, it is important to determine and correct the source of the problem as quickly as possible. Potential reasons include dictation delays, incomplete chart packs, or slow submission of claims data. • Accounts Receivable (A/R) Over 90 Days in Excess of 15 percent: Utilize reporting data to determine what may be driving an increase in revenue over 90 days. The source may be attributed to numerous unpaid claims, patient bal- ances, or unadjusted accounts, or a lack of follow up and maintenance on the A/R. It is also critical to know claims rejection and denial percent- ages to identify the underlying reasons and take corrective action. 8. Neglecting payment posting. Payment posting is a process that should be performed properly and in a timely manner. Daily payment posting and maintaining a current reconciliation are strongly recommended. Explanation of benefits should be thoroughly reviewed and understood by payment posters to help identify indicators of payment issues or processing errors. It is also important to stay on top of credit balances to mini- mize bad debt write-offs. Balances should be dropped to the secondary insurance or patient as soon as the claim is correctly adjudicated. 9. Unreconciled billing. It is very important for ASCs to recon- cile billing to ensure all performed cases are billed. It is equally important to track and understand the reasons for unbilled cases. It is not uncommon for billers or billing companies to miss reconciling the billing to the clearinghouse. Rejections and denials should be monitored through the clearinghouse. 10. Coding errors. Coding is one of the most important func- tions in the revenue cycle. Common errors have the potential to significantly impact financial performance. These include not coding at the highest level, missing implants, not coding bilateral procedures, not using the correct modifiers, unbun- dling, and not coding for payable supplies. Per Medicare guidelines, CPT codes submitted should be the same between the surgeon and the ASC. Communicate regularly with sur- geons' offices to avoid payer delays due to coding discrepan- cies between claims. If coding is performed at the facility, ensure that the coding team receives ongoing ASC coding training and education on the most current coding rules as well as changes in federal regulations. If coding is outsourced, employ a vendor partner staffed with experienced, certified ASC coders. Take control of your financial health Effective management of the revenue cycle, from schedul- ing to payment, by certified, skilled professionals is the single most important factor to positively impact the financial health of an ASC. To determine the financial health of your facility, request a revenue cycle assessment from a leading revenue cycle management vendor to identify current process and workflow weaknesses. If staffing a skilled revenue cycle team is a challenge, consider outsourcing. Significant efficiencies and bottom-line improve- ments can be realized by partnering with a vendor that offers leading technology solutions and services throughout the continuum of care. On a final note, partner with a vendor that offers complete transparency and control of the ASC revenue cycle along with key analytics, actionable insights, recommendations, and proven strategies. Such offerings will maximize the ASC's ef- ficiency, profitability, and physician disbursements. n "Effective management of the revenue cycle, from scheduling to payment, by certified, skilled professionals is the single most important factor to positively impact the financial health of an ASC." Surgical Notes is a nationwide provider of revenue cycle solutions that include transcription, coding, billing, and docu- ment management applications for the ASC industry. The largest management companies and over 20,000 healthcare providers trust Surgical Notes' cutting-edge, innovative solutions to enhance the financial strength and performance of their ASCs. Surgical Notes' team of certified, experienced professionals, in combination with strong business intelli- gence analytics, provide customized, data-driven revenue cycle strategies. By assimilating Surgical Notes' products and services, ASCs have access to an enterprise revenue cycle solution geared toward maximizing profitability, physician disbursements, and business office efficiency. Contact us at (800) 459-5616 or visit www.surgicalnotes.com to learn more.

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