Article - Increasing Reimbursement for Ambulatory Surgical Center (Part 1)

How can you gain better control over your ASC's revenue cycle performance? By monitoring key performance indicators (KPIs). This first in a two-part series identifies more than 15 ASC revenue cycle KPIs worth tracking. It explains the importance of monitoring each KPI, offers target benchmarks (where applicable), and identifies warning signs to watch for that may indicate a KPI is moving in the wrong direction. Part two will share common problems that can contribute to poor KPI performance, describe solutions to help address obstacles to success, and provide guidance for effectively analyzing trends.

Days to Bill/Charge Lag

Common problems:

·         High provider dictation days. The goal should be same-day dictation.

·         Providers not responding to coding queries or amending operative notes upon request.

·         Missing documentation (e.g., pathology report, history and physical, implant log, invoice).

·         Billing team issues (e.g., lack of resources, poor time management, workflow inefficiencies, insufficient knowledge of rules and processes).

Solutions:

·         Require providers to dictate on the same day of the surgery. Implement a policy that penalizes providers who do not dictate in a timely manner.

·     Establish an efficient process for business office staff to submit requests (e.g., coding questions, report amendments) to providers and receive timely responses.

·       Closely track any missing documentation to ensure timely responses to payer requests. Note: Do not hold up billing for implant pricing if the implant is not covered by the payer.

·      Address billing team deficiencies immediately. Improve the likelihood of identifying issues by monitoring team productivity, days to the bill, clean claim submission percentage, tracking of held cases, and charge entry accuracy.

Days to Pay

Common problems:

·         Billing delays.

·         Charge entry or demographic entry errors that trigger rejections or denials.

·         Paper claim submission.

·         Failure to follow up on initial claim submission in a timely manner.

Solutions:

·         Review the insurance and insurance identification entered in the demographic screen prior to claiming submission to verify accurate entry.

·         Perform quality assurance (QA) review of charges prior to claim submission.

·         If a payer requires paper claim submission via USPS mail, follow up with the payer within 14 days to confirm the claim was received and is on file. Problems with paper claims submissions can contribute significantly to an increase in the metric.

·         Follow up on all claims within 21 days of submission to ensure the claim was received and is in processing. This will also help identify denials sooner.

Specialty Volume Trending

Common problems:

Negative case volume is typically attributed to poor scheduling, cancellations, and/or declining referrals.

Solutions:

Trend volume monthly. This will help identify whether a top-paying specialty(s) has declined in volume. If such a decline is occurring, initiate a discussion with providers and business office leaders to determine the cause(s) of the volume decrease.

Payer Volume Trending

Common problems:

Negative case volume is typically attributed to poor scheduling, cancellations, and/or declining referrals.

Solutions:

Trend volume monthly. This will help identify whether a top-paying payer(s) has declined in volume. If such a decline is occurring, initiate a discussion with business office leaders to determine the cause(s) of the volume decrease. Pay close attention to cancellations and their reasons.

Accounts Receivable (AR) > 90

Common problems:

·         Initial follow-up not occurring in a timely manner.

·         Required invoices not submitted in a timely manner.

·         Claim submission errors.

·         Denials and appeals not addressed in a timely manner.

·         Patient balances not worked diligently.

·         Balance not resolved or dropped to the secondary insurance/patient after payment posting.

Solutions:

·         Work all claims within 21 days of claim submission to ensure they are received and in process. Confirm that the payer requires no additional information.

·         If the case includes a covered implant(s) but the invoice is not available upon claim submission, track and submit the invoice as soon as it is available.

·         Perform QA review of all charges prior to claim submission to avoid errors that may delay payment and age the account.

·         Identify all denials in a timely manner and address them within 48 hours of receipt. Submit appeals within 48 hours of receiving a low or incorrect payment.

·      Treat patients balance AR as important as insurance AR. Work patient balances consistently. Implement a process to refer patients to collections when patients are unresponsive to outreach efforts and statements.

·         Once paid by the primary payer, immediately drop the balance to the secondary insurance or patient.

Days in AR (i.e., Days Sales Outstanding)

Common problems:

·         High percentage of litigation cases, workers' compensation cases, and/or out-of-network cases.

·         AR not worked effectively or in a timely manner.

·         Secondary insurances and/or patient balances not resolved in a timely manner.

·         Appeals or denials not addressed in a timely manner.

·         Problems associated with high AR greater than 90.

Solutions:

·         Monitor days in AR by financial class to better determine offenders.

·         Create reasonable benchmarks for each payer type. If even a slight increase occurs, there are likely recurring issues.

·       Review cases under the offending financial class to better identify the reason(s) for the increase. Reviewing days in AR by financial class can help isolate the offenders without specific types of cases skewing the numbers.

·         Complete an audit of the AR to further determine the reasons why a specific financial class has higher days in AR. Focus on the problems listed above.

Days to Dictate

Common problems:

·         Provider failing to perform timely dictation.

·         Provider failing to review and sign off on operative notes in a timely manner.

Solutions:

·         Establish a dictation standard for each provider to follow. Rule of thumb: Dictate on the same day of the surgery.

·         Create incentives and consequences for timely and untimely dictation.

Understanding the importance of monitoring revenue cycle KPIs benchmarks to strive for, and warning signs that may indicate suffering KPI performance is vital to ensure a highly productive revenue cycle. The second article in this two-part series will share common KPI performance problems, solutions to help overcome obstacles and guidance for analyzing trends.

When it comes to ASC medical billing, Medical Billers and Coders (MBC) is one of the leading service providers. With our 15+ years of experience in the medical billing domain and with our proven ASC medical billing services, many surgical centers across the country have overcome denials and underpayments. Our billing professionals not only specialize in ASC coding and billing but also incorporate the knowledge throughout the process. To know more about our ASC medical Billing services you can contact us at 888-357-3226/info@medicalbillersandcoders.com


Published By - Medical Billers and Coders
Published Date - Feb-27-2020 Back

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