Selecting the right
revenue cycle management (RCM) company as your business partner can be challenging. To assist you
in making an educated decision, here are 30 services your ASC should expect
from an RCM partner.
1. Provide a proven quality assurance (QA) process.
2. Provide a QA review of demographics to ensure information is entered correctly
in the practice management system to avoid unnecessary rejections or denials.
3. Periodically audit its coding department using a third-party vendor, with
results provided to client centers.
4. Provide clients with ongoing education if dictation is lacking details,
which can affect the codes issued.
5. Scrub and review all claims prior to submission to the clearinghouse.
6. Provide its billing team with training on how to submit a claim electronically,
on paper, or by fax, and what documents must be included as attachments.
7. Ensure the billing team confirms contractual adjustments are taken up front.
8. Perform medical charts review to ensure all appropriate supplies and implants
9. Perform 100% billing reconciliation. Provide weekly reports to clients
that reflect all unbilled cases along with an explanation of why they
10. Address rejections and resubmit corrected claims within 24 hours. Rejection
reasons are tracked, and ongoing education is provided to staff and the
facility to avoid future rejections for those reasons.
11. Communication to the center when there is a discrepancy between coding
and what was authorized.
12. Communication to the center concerning any missing information on the
benefit verification and documentation received.
13. Communication to the center when any performed procedures are not payable
per the contracts or local coverage determination.
14. Handle all claim resubmissions, appeals, and denials.
15. Provide initial claims follow-up 14 days after submission to confirm the
claim is on file and being processed.
16. Implement a proven process for the accounts receivable workflow to ensure
cases do not "slip through the cracks." Each RCM partner team
member undergoes regular audits to ensure each account is aggressively
worked in order to achieve a resolution.
17. Complete payment posting within 24 hours of payment receipt. Payments are
posted exactly per the explanation of benefits (EOB). Underpayments are
identified immediately and escalated to the appropriate representative
at the carrier level so they are handled within 24 hours.
18. Communicate with the client center's administration when there are
discrepancies with the contracted payments.
19. Use a denial management system to trend denial reasons utilizing analytics
in order to avoid denials in the future. The RCM partner communicates
these issues back to the center to avoid future revenue leakage by tracking
the root cause of the denials and taking corrective action.
20. Complete payment reconciliation to ensure all electronic funds transfers
(EFTs), checks, patient deposits, cash, and credit cards are accounted
for and posted into the practice management system.
21. Provide feedback to the center if patient responsibility estimates are
incorrect and/or not enough money is collected up front.
22. Perform chargemaster analysis to ensure center charges are appropriate
for the area and contracts.
23. Provide analysis and feedback on managed care contracts. Full-service RCM
companies will help centers negotiate or negotiate on their behalf. The
RCM partner should communicate any issues observed with contracts that
may affect revenue.
24. Handle provider credentialing, payer re-credentialing, payer enrollments,
electronic remittance advice enrollments, and EFT applications to avoid
additional fees associated with payers that pay via virtual credit cards.
25. Provide customized patient statements and makes routine phone calls to patients.
26. Work directly with a center's collection agency vendor.
27. Provide access to meaningful benchmarks to compare data to other facilities
in the center's geographical location as well as in-network and out-of-network averages.
28. Record real-time updates and notes in the practice management system.
29. Use business intelligence analytics to report performance trending with
all key performance metrics to the center. This provides complete transparency
and encourages a proactive approach to improvement.
30. Offer to help prepare board and ad-hoc reports, and offer to customize reports.
This may seem like a lot to expect from an RCM partner, but all these services
are necessary for a complete revenue cycle process that functions in a
timely manner and supports other essential business tasks. If an RCM company
does not provide some of these services, your ASC will need to perform
them in-house or find another company to fill the void. This is likely
to create inefficiencies as information will need to be reconciled between
the RCM company and in-house staff and/or another company. And when inefficiencies
creep in, costs quickly creep up.
Do you have additional questions about selecting an RCM partner? Want to
know why Surgical Notes is the RCM partner of choice for ASCs nationwide?
Contact us today. We welcome the opportunity to speak with you and tell you why we believe our
SNBilling RCM service is the right one for your ASC!