In today's fluctuating economy, ASCs are looking for ways to increase their reimbursement while remaining competitive and compliant. The first place to look should be your accounts receivable balances to determine if all accounts are being paid in full. To properly collect your ASC's outstanding amounts, your personnel must be meticulous in tracking all facets of reimbursement, both before and after the services are rendered. The following is a list of six areas where dollars can be won or lost before the claims have even been submitted.
Area #1: Scheduling — Acquiring necessary patient information
Let's start at the beginning. The surgeon's office calls, faxes or e-mails to schedule a procedure. The amount and type of demographic and insurance information they send is often insufficient to properly perform insurance verification. However, rather than bother the busy surgeon's office again, remember that the patient is the best source for the information you need. Even though your ASC's business office may be short-staffed and calling the patient may take a little extra time, it's a good time to make that first friendly contact and show that you are working on their behalf to verify their insurance coverage. Let them know that your office will call them back with that information as soon as you receive the necessary information from their insurance company.
Area #2: Registration — Entry of complete patient information
It's extremely important that the information received from every source is entered accurately into your computer system — after all, this is the information that is used to bill the insurance company and the patient. Remember the old adage: GIGO (garbage in, garbage out). Nowhere is it truer than in insurance billing. Medicare's #2 reason for claim denials is incomplete or invalid information, i.e., misspelling of name, wrong or missing ID number, etc.
Area #3: Insurance verification — Verifying payment by third-party payors
The best advice is to use some sort of reminder of all of the information to request. A good verification form is priceless. If the insurance section of your software is complete enough to remind you of all of the information needed, then use it (but I have yet to see one that has areas that ask for all the pertinent information). Remember that the information you need for a commercial claim is different than what you need for workers' compensation. Don't forget to recheck the mailing address for the claim — it is frequently different from that listed on the back of the card.
Area #4: Patient financial counseling — Advising patient of fiscal responsibility
If you had to contact the patient for additional information previously, you are already a step ahead as they are prepared for your call about insurance coverage. Whether it's the first or second contact, a positive and helpful attitude go a long way in asking for payment. Explain what the facility fee is for, the amount of insurance (and secondary insurance) coverage and their estimated financial responsibility. Also let them know there will be other fees due from the surgeon, possibly the lab, x-ray, etc. Clarify differences between co-pays, deductibles and co-insurance and tell them how much is due on the day of surgery. If the amount is large and the patient expresses concern, explain the different ways to pay, i.e., credit cards, healthcare credit, credit card monthly debits, etc. Get a commitment on method of payment prior to them coming
for the procedure.
Area #5: Up-front collections — Handling patient payments day of surgery
Be prepared. You have already discussed with the patient the amount of payment due on the day of surgery and the method of payment. You have documented this information in the computer system. Alert the registration clerk as to what amount of money the patient is expected to pay and provide them with any documents that the patient needs to sign. It's important that your surgery center have a semi-private area to discuss financial and clinical information, which also allows patients to sign documents and provide payments.
Area #6: Dictation and transcription — Importance of full disclosure
Accuracy and completeness of the operative note is essential in determining what you are going to be paid. The ASC should provide a quiet and comfortable area for the surgeon to dictate. Surgeon education on how certain areas of the operative note need to be clarified can also be helpful. Procedures that were performed which can often provide additional reimbursement are frequently not identified in the operative note, as well as not mentioning implants and ancillary procedures provided. A quote attributed to CMS advised, "If it's not documented, it never happened." Areas often needing additional attention for dictation are:
Part two of "Collecting Full Payment," which will cover areas including coding, billing and collections, will appear in June on Becker's ASC Review.
Learn more about Serbin Surgery Center Billing at www.ascbilling.com.
Area #1: Scheduling — Acquiring necessary patient information
Let's start at the beginning. The surgeon's office calls, faxes or e-mails to schedule a procedure. The amount and type of demographic and insurance information they send is often insufficient to properly perform insurance verification. However, rather than bother the busy surgeon's office again, remember that the patient is the best source for the information you need. Even though your ASC's business office may be short-staffed and calling the patient may take a little extra time, it's a good time to make that first friendly contact and show that you are working on their behalf to verify their insurance coverage. Let them know that your office will call them back with that information as soon as you receive the necessary information from their insurance company.
Area #2: Registration — Entry of complete patient information
It's extremely important that the information received from every source is entered accurately into your computer system — after all, this is the information that is used to bill the insurance company and the patient. Remember the old adage: GIGO (garbage in, garbage out). Nowhere is it truer than in insurance billing. Medicare's #2 reason for claim denials is incomplete or invalid information, i.e., misspelling of name, wrong or missing ID number, etc.
Area #3: Insurance verification — Verifying payment by third-party payors
The best advice is to use some sort of reminder of all of the information to request. A good verification form is priceless. If the insurance section of your software is complete enough to remind you of all of the information needed, then use it (but I have yet to see one that has areas that ask for all the pertinent information). Remember that the information you need for a commercial claim is different than what you need for workers' compensation. Don't forget to recheck the mailing address for the claim — it is frequently different from that listed on the back of the card.
Area #4: Patient financial counseling — Advising patient of fiscal responsibility
If you had to contact the patient for additional information previously, you are already a step ahead as they are prepared for your call about insurance coverage. Whether it's the first or second contact, a positive and helpful attitude go a long way in asking for payment. Explain what the facility fee is for, the amount of insurance (and secondary insurance) coverage and their estimated financial responsibility. Also let them know there will be other fees due from the surgeon, possibly the lab, x-ray, etc. Clarify differences between co-pays, deductibles and co-insurance and tell them how much is due on the day of surgery. If the amount is large and the patient expresses concern, explain the different ways to pay, i.e., credit cards, healthcare credit, credit card monthly debits, etc. Get a commitment on method of payment prior to them coming
for the procedure.
Area #5: Up-front collections — Handling patient payments day of surgery
Be prepared. You have already discussed with the patient the amount of payment due on the day of surgery and the method of payment. You have documented this information in the computer system. Alert the registration clerk as to what amount of money the patient is expected to pay and provide them with any documents that the patient needs to sign. It's important that your surgery center have a semi-private area to discuss financial and clinical information, which also allows patients to sign documents and provide payments.
Area #6: Dictation and transcription — Importance of full disclosure
Accuracy and completeness of the operative note is essential in determining what you are going to be paid. The ASC should provide a quiet and comfortable area for the surgeon to dictate. Surgeon education on how certain areas of the operative note need to be clarified can also be helpful. Procedures that were performed which can often provide additional reimbursement are frequently not identified in the operative note, as well as not mentioning implants and ancillary procedures provided. A quote attributed to CMS advised, "If it's not documented, it never happened." Areas often needing additional attention for dictation are:
- Bilateral or multiple procedures
- Identification of surgical site, e.g., fingers, toes (needed for modifiers)
- Specific areas treated, e.g., medial or lateral compartment
- Detailed implant information
- Ancillary procedures performed
- Deviation from normal, i.e., more time, complications
- Postoperative pain management details
Part two of "Collecting Full Payment," which will cover areas including coding, billing and collections, will appear in June on Becker's ASC Review.
Learn more about Serbin Surgery Center Billing at www.ascbilling.com.