If the ASC is losing out on their revenue due to coding, collection and billing blips some serious measures need to be taken to arrest them. As for any practice, efficient billing and collections are essential for the success and profitability of the center, and for ASCs it is no different. Hence, efforts need to be made to make sure that efficiency of the billing team improves so that they can capture more money. Similarly, when claims are denied they result in lower revenues which endanger profitability and also cast a shadow over the integrity of the processes and workflow of surgery centers.
Reasons for loss of revenue and high rate of denials-
There are several reasons due to which ASCs lose out on revenue. Stated below are a couple of points:
- Lack of proper authorization for performing services and procedures: In cases where they get referrals from physicians who have no ties with them, they fail to get proper authorization for the services rendered. This compels them to contact the payer and get information about the patients benefit plan and go over the financial obligation like co–payments, deductibles and services covered and how will they receive payment.
- Hiring unqualified and inexperienced coders: Getting a certified coder is vital as they send out the right codes due to which the center receives proper reimbursement. Lack of appropriate exposure to coding and billing will give rise to increasing errors and subsequently denials putting you in financial crunch.
- Missing documentation attached to the claim: Payers may ask for additional documentation such as the operative note or implant invoice etc. These demands may change from one situation to the other, resulting in persistent claims.
- Incomplete or missing information- Claims are commonly denied on the grounds of inaccurate or incomplete patient information such as subscriber ID number, date of birth and/or date of injury. Any sort of missing information on the claim happens to be one of the major reasons for claims being denied.
Curb the loss of revenue
ASCs need to take these steps to make sure that they improve on their revenue stream.
- In most cases top health insurance companies have member health plans published online and member benefits can be checked by plugging in procedure codes and finding out the coverage of the insurance plan. However, the trick is to put in the correct parameters. Hence, it is important that the staff understands the system and plugs in the correct information.
- ASCs must ensure they audit the records, business office and processes regularly for a smooth functioning. The medical record manager should make it a point to check that the coders are following proper procedures and the leadership should take on the onus of keeping a track of the collection of co–insurance and co-payments.
- In order to avoid receiving constant requests for additional documentation, it is advised to get a clear understanding from the payer on the documents needed to get the claim paid.
- Having one of the staff members call the patient prior to the appointment and confirming all personal information can save much time and efforts. This can also help avoid errors occurring when a patient unexpectedly switches their insurance plan.
The ASCs have improved their overall operating standards and made sure that they implement proper processes and procedures so that they do not lose out on revenue. Following simple tips can help ASCs see a surge in revenue and a dip in denials.