3 things ASCs can do now to jumpstart revenue in 2020

Denied claims present a significant challenge for healthcare providers. Appealing denials costs healthcare organizations an estimated $8.6 billion annually, according to a 2017 analysis. Due to the high cost and administrative burden associated with appealing denied claims, many providers forgo the process for claims that could be successfully reworked, leaving potential reimbursement on the table.

In a Jan. 22 webinar sponsored by Collect Rx and hosted by Becker's ASC Review, Collect Rx CEO John Bartos and Pat O'Connor, vice president of business development for Collect Rx, discussed current payer trends and strategies ASCs can use to jumpstart revenue in 2020 by tackling the claims process.

"You need a good collections program to be in a position to take advantage of the [revenue] opportunities there," Mr. Bartos said.

ASCs can use data, evaluate processes and evaluate staff performance to improve the payer collections and claims recovery process to increase revenue.

Trends in patient billing and payer reimbursement

Increased patient responsibility and increasing surgery expenses are two prominent trends influencing patient billing.

Patients are experiencing negative effects on health and financial wellbeing by delaying procedures due to the cost. NORC at the University of Chicago, a non-partisan research institution, estimates that 40 percent of patients skip medical procedures due to cost.

However, when patients do undergo procedures, they often don't pay the bill in full. According to an analysis by TransUnion, 85 percent of hospital bills ranging from $500 to $1,000 were not paid in full in 2016.

Optimizing payer collections and revenue recovery

According to the U.S. Department of Labor, one claim out of seven is denied, resulting in over 200 million denied claims annually.

"The biggest reason you want to focus your efforts on payer collections is the money," Mr. O'Connor said. "Providers today are collecting less and spending more than they have historically, and denials and underpayments continue to increase."

According to Mr. O'Connor, there are three steps to maximizing payer collections:

1. Use data. Analyzing data at the procedure and provider level can help identify where collections are stalled. ASCs should consider evaluating trends over time instead of focusing on one component of their revenue cycle.

2. Evaluate processes. Reviewing revenue cycle processes in detail allows ASCs to identify areas for improvement. Using new tools like claims scrubbers and encoders can help revenue cycle processes run more smoothly.

3. Review resources. To maximize payer collections, ASCs can add additional billing staff or adjust workflows to account for staff strengths and weaknesses. Key coding staff areas to focus on include the number of claims processed, as well as the collections and error rate.

Conclusion

Payer collection management can help improve provider financial performance, Mr. Bartos said. ASCs can achieve financial success through a strong collections program that focuses on data, streamlined processes and staff improvement.

"Partner with someone who understands the tactics the payers use and has the tools, processes and know-how so you can receive the reimbursement you're entitled to," Mr. O'Connor said.

Click here to learn more about Collect Rx, and listen to the full webinar here.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast