A colleague once told Josiah Lamz, director of marketing for MedBridge, there are three ways to improve the financial health of your facility: add cases, cut costs or improve your billing, coding and collections process. He discusses five ways to use your revenue cycle to maximize payment for every case.
1. Educate pre-operative phone call staff on case reimbursement. In Mr. Lamz' experience, staff members responsible for the pre-operative phone call to the payor, during which patient benefits are verified, often lack knowledge on case reimbursement. "There's a lack of communication and sharing of knowledge between surgery center departments and in the business office," he says. "If you're the person doing the phone calls to insurance to verify benefits, you're probably not the same person who will open the mail and post payments to the account, or follow up on denials or underpaid claims."
He says because these roles are often separated in the ASC, staff members need to communicate about reimbursement. "If the pre-op person has information on what cases reimburse, they can make the phone call [to the payor], find out the patient's benefits and then make recommendations if the particular case won't cover costs because of the patient's benefits," he says. "They can say to the surgery center, 'Maybe we should move this case somewhere else because otherwise we'll take a loss.'"
2. Calculate expected reimbursement before billing every case. The billed amount and the collected amount for an ASC case are often very different. Depending on the patient's benefits, the ASC may end up collecting much less than they bill for. If the staff member who posts payments to the account has not communicated with the biller, they may not know when a payment is unusually low or the payor has made an error. To solve this problem, Mr. Lamz says ASC staff should establish an expected amount for every single case. "If that's not done, there's no red flag if the payment was less than it should have been, and there's nothing to compare the payment to," he says. "If a payment is received and it does not match the expected amount, it should go to the collector to determine why it was underpaid."
For a procedure that generates four or five different codes, the most expensive code is listed first because each code after the first one will pay at 50 percent. "That doesn't happen all the time, but it's very common for third-party payors and for workers' comp," he says. Establishing an expected payment before billing is much easier than asking the person who deposits payments to look at five codes and do the math to figure out if the payment is correct.
3. Follow up on every underpaid contracted case. If your ASC receives an underpayment from a contracted payor, Mr. Lamz recommends looking into the error every time. "If it's happening multiple times and you're underpaid on a regular basis, I would recommend you contact the contract manager for the payor directly and say, 'You need to load our contract again [in your system] because it's not calculating the proper reimbursement,'" he says. Contacting the contract manager directly will save you the tedium of appealing every five-dollar underpayment from your contracted payors.
4. Pick your battles on out-of-network payments. Payment for non-contracted cases is much more irregular, and often your ASC will not receive the payment you expect. Sometimes the payment will be higher than anticipated, and sometimes it will be lower. "You kind of have to pick your battles," he says. "You should look at OON payments on a case-by-case basis, depending on what you received." If you receive much less than you expected, you should call the payor to determine why the case was paid the way it was.
5. Set up a website to let patients pay online. If you want to receive maximum payment for every case you do, you should make sure patients have multiple easy payment options. "I would recommend that a surgery center accepts credit cards, and also communicate very clearly about the fact that patients can use a major credit card, cash or check," Mr. Lamz says. "There should also be a secure website so the patient can submit a payment."
He says payment can also be made over the phone, but patients will often expect to be able to pay their bills online and might become frustrated if your surgery center does not allow it. Before the procedure, send the patient a letter or make a phone call to let them know your various methods of payment.
Learn more about MedBridge Surgery Center Billing.
Read more ASC revenue cycle advice:
-8 ASC Coding Tips for Orthopedic Procedures
-5 Best Practices to Improve Your ASC's Revenue Cycle
-8 Common Coding Errors for 7 ASC Specialties
1. Educate pre-operative phone call staff on case reimbursement. In Mr. Lamz' experience, staff members responsible for the pre-operative phone call to the payor, during which patient benefits are verified, often lack knowledge on case reimbursement. "There's a lack of communication and sharing of knowledge between surgery center departments and in the business office," he says. "If you're the person doing the phone calls to insurance to verify benefits, you're probably not the same person who will open the mail and post payments to the account, or follow up on denials or underpaid claims."
He says because these roles are often separated in the ASC, staff members need to communicate about reimbursement. "If the pre-op person has information on what cases reimburse, they can make the phone call [to the payor], find out the patient's benefits and then make recommendations if the particular case won't cover costs because of the patient's benefits," he says. "They can say to the surgery center, 'Maybe we should move this case somewhere else because otherwise we'll take a loss.'"
2. Calculate expected reimbursement before billing every case. The billed amount and the collected amount for an ASC case are often very different. Depending on the patient's benefits, the ASC may end up collecting much less than they bill for. If the staff member who posts payments to the account has not communicated with the biller, they may not know when a payment is unusually low or the payor has made an error. To solve this problem, Mr. Lamz says ASC staff should establish an expected amount for every single case. "If that's not done, there's no red flag if the payment was less than it should have been, and there's nothing to compare the payment to," he says. "If a payment is received and it does not match the expected amount, it should go to the collector to determine why it was underpaid."
For a procedure that generates four or five different codes, the most expensive code is listed first because each code after the first one will pay at 50 percent. "That doesn't happen all the time, but it's very common for third-party payors and for workers' comp," he says. Establishing an expected payment before billing is much easier than asking the person who deposits payments to look at five codes and do the math to figure out if the payment is correct.
3. Follow up on every underpaid contracted case. If your ASC receives an underpayment from a contracted payor, Mr. Lamz recommends looking into the error every time. "If it's happening multiple times and you're underpaid on a regular basis, I would recommend you contact the contract manager for the payor directly and say, 'You need to load our contract again [in your system] because it's not calculating the proper reimbursement,'" he says. Contacting the contract manager directly will save you the tedium of appealing every five-dollar underpayment from your contracted payors.
4. Pick your battles on out-of-network payments. Payment for non-contracted cases is much more irregular, and often your ASC will not receive the payment you expect. Sometimes the payment will be higher than anticipated, and sometimes it will be lower. "You kind of have to pick your battles," he says. "You should look at OON payments on a case-by-case basis, depending on what you received." If you receive much less than you expected, you should call the payor to determine why the case was paid the way it was.
5. Set up a website to let patients pay online. If you want to receive maximum payment for every case you do, you should make sure patients have multiple easy payment options. "I would recommend that a surgery center accepts credit cards, and also communicate very clearly about the fact that patients can use a major credit card, cash or check," Mr. Lamz says. "There should also be a secure website so the patient can submit a payment."
He says payment can also be made over the phone, but patients will often expect to be able to pay their bills online and might become frustrated if your surgery center does not allow it. Before the procedure, send the patient a letter or make a phone call to let them know your various methods of payment.
Learn more about MedBridge Surgery Center Billing.
Read more ASC revenue cycle advice:
-8 ASC Coding Tips for Orthopedic Procedures
-5 Best Practices to Improve Your ASC's Revenue Cycle
-8 Common Coding Errors for 7 ASC Specialties