Effective Billing Methodologies- A Recipe for ASC Profitability

July 13, 2016

../../images/articles/Effective Billing Methodologies- A Recipe for ASC Profitability.jpg

Billers in an ASC setting play a significant role in profitable Ambulatory Surgical Centers. Ensuring complete reimbursements depends on the ability of the biller to submit accurate claims on a timely basis. In order to assist facilities get a better grip on their revenue, it is pertinent for an effective billing process to be in place. The first step involved in enhancing collections is the root of the process- as easy as validating insurance eligibility.

In order to achieve success with ASC billing, it is important that the staff handling the billing is efficient, effective and adept with the intricacies revolving and ASC billing process. The right revenue cycle specialist plays a vital role in the financial health of the Ambulatory Surgical Center.

Industry Highlights-

Ambulatory surgery centers spend an average of $1.42 million on employee wages
Making use of an EHR in an ASC can reduce costs by 3 percent

A few tips to assist in ensuring profitability in an ASC.

  • Scheduling-
    Conflicts in the schedule is one of the biggest reasons for lost revenue. Scheduling is an important part of the billing process. Inefficient scheduling can lead to canceled visits, which translates into losses. However, latest technology enables facilities with an automated scheduling process which helps avoid loss of revenue owing to no shows. It can help physicians in identifying number of rooms available thus patients do not have to wait longer neither are rooms left idle.
  • Check eligibility verification-
    Validating the insurance coverage helps avoid delays in billing and helps claims filing with minimal errors. Automated processes are solutions to this step, simplifying the process. Checking for verification at this stage will avoid glitches during claim submission which will reflect in the payments.
  • Cash Posting-
    It is critical to make sure that the cash posting is accurately done. The initial responder is the one who identifies inaccurate payments. This is where a range of processes is controlled.
  • Understand ASC state regulations-
    It is pertinent to understand the regulatory body that oversees the Ambulatory Surgical Centers in your state. The regulations differ with states, especially with the licensing and certification that need to be adhered to in order to ensure full reimbursement.
  • Use EHR-
    EHR systems provide valuable and necessary information, with the ability to enter all the details and share this information electronically which will assist in eliminating redundant paper processes. The EHR can help post transactions, generate claim files and submit them electronically to the insurance company.
  • Follow up-
    The balance remaining in patient accounts should be monitored followed up on a regular basis. Be familiar with costs associated with collection activities to categorize a point where remainders can be written off in order to avoid chasing an amount that does not justify the costs associated with the service. This will save time and revenue.
  • Perform internal audit-
    Conducting an internal audit will help understand how the office is operating. It also helps in analyzing if the coding is being done in the manner desired and full reimbursements are being collected. In case of any problems, the audit will bring them to light and you can make the necessary amendments.

The key to an effective billing process is generating data and accurately analyzing it, along with a thorough follow up. However the billing process is a constant struggle for many ASCs and is the biggest reason for lost revenues. Thus, a few pointers as mentioned above can help ease down matters and bring about a smooth revenue flow.


Category : Best Billing and Coding Practices