Caryl Serbin, executive vice president and chief strategy officer for SourceMedical, recommends ambulatory surgery centers take the following 20 steps to improve collections from third-party payors.
1. Determine accuracy of registration information prior to submitting claim.
2. Shortly after claim submission, check to make sure payor has claim on file.
3. Make the first follow-up in approximately two weeks.
4. Additional follow-ups should be conducted at least every 30 days.
5. Develop company-specific protocol for handling delinquent payors.
6. Respond immediately to payor requests (i.e., operative notes, invoices, etc.).
7. Keep payor contracts and fee schedules updated in your software.
8. Know and understand the terms in your contracts and your state's prompt payment requirements. Enforce these with your payors.
9. Be aware of each payors timely filing requirements for appeals and corrected claims.
10. When applicable, involve the payor's provider representative regarding reimbursement issues.
11. For improperly paid claims or claims not paid in a timely manner, copy your state insurance commissioner when necessary.
12. Document all correspondences with payors, including date, name of payor representative and any actions.
13. Set goals for collectors and enforce them; offer an incentive for consistently meeting goals.
14. Check aging report by payor weekly.
15. Use customized appeal letters and always include supporting documentation.
16. Ask questions that require more than a form letter response from payors.
17. Take appeals to highest level of adjudication.
18. Understand your billing software and its abilities.
19. Develop a method of tracking all denials in order to identify similarities.
20. Follow up on all clearinghouse denials.
Learn more about SourceMedical Revenue Cycle Solutions.
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