For Ambulatory Surgery Centre’s (ASC), 2017 was a mixed year as far as financials are concerned. Some performed extremely well due to efficient billing and collection, while some suffered due to unpaid collections.
With the rise of high-deductible health plans and pressure on reimbursement rates, many ASC’s are trying to improve collection rates to maintain or boost their financial performance in 2018.
Start by looking at write-offs for claim denials that you couldn't appeal because a process failed (example timely filing) or you were missing critical data (example authorization).
These write-offs are essentially lost revenue and drive down your collection efficiency. By focusing on filtering processes and ensuring appropriate upfront data collection can prevent or minimize the revenue loss.
Along with this the ASC should also focus on patient collections. There has been a significant shift to higher deductible/cost-sharing plans that place a lot of responsibility on patients for payment. There is a cut-throat competition for patient dollars, making it difficult to collect those un-paid dollars. Channelizing ways to improve upfront patient collections can improve collection rates for after insurance balances.
Billing patients in ways they prefer cannot be understated. Alterations in healthcare have made patients the third largest payer behind Medicare and Medicaid. Unlike the other two, it’s hard to collect from the patient and takes more time and money to secure payment. Electronic bills and payment capabilities will improve collection rates, especially when they are readily understood.
A recent survey conducted by payer found that 71 percent of respondents would promptly pay their bills if they were understandable and, more importantly, matched a payer's explanation of benefits.
Without delving into the why's and how's, all of us know that healthcare bills to patients have been getting bigger. Instead of swallowing hard as write-offs grow, build in automated payment plans into your process for those people who want to pay but need assistance to accommodate their income.
Patients are not deadbeats. They'll pay proper and correct medical bills and will be more willing to do so if it can be done in bite-sized pieces.
Claims denial is the foremost reason Ambulatory Surgery Centre’s (ASC) run into losses. The first step to tackling denials is accurately identifying their root cause, which can be difficult for many ASC. Employing the services of a dedicated revenue cycle manager or medical biller and coder can solve this issue to some extent.
The next step is outlining best-fit workflows that route those denials to the appropriate team, at the appropriate time, for resolution. Workflow automation increases collection efficiency. Focusing on process improvements in small steps will make a big, positive impact on collection success.
Observe the timeliness. Check whether the insurance side, are clean claims going out in a timely way? If not, determine whether providers are documenting daily/weekly/monthly. Evaluate is the medical coders are keeping up, and identify any inefficiency prohibiting the claim edits from being resolved in a timely manner.
Similarly, on the patient reimbursement, check what is holding patient statements from being sent in a timely manner? Look for unnecessary patient statement holds or delays, look at the volume of mail returns on patient statements, determine if registration issues exist and ensure patient disputes are processed in a timely fashion.
Using the above-mentioned checklist you can improve your upfront collections for the Ambulatory Surgery Centre’s (ASC).