By Angela Mattioda, Sr. Vice President of RCM Solutions & Client Experience
The complete ASC revenue cycle is comprised of numerous functions. These
include everything from insurance verification and dictation to coding,
claim submission, and collections. Every function must thrive individually
and, due to their interdependence, collectively. When they perform well
on their own and together, the revenue cycle management process accelerates
which brings improvements in efficiency, effectiveness, and financial
To help your ASC better achieve and maintain a high-performing revenue
cycle, here are tips that can help you improve four of the most frequently
overlooked elements of revenue cycle functions.
1. Payer-specific billing rules
While billing rules can overlap between payers, there are typically substantial
differences concerning what's required to submit clean claims and
receive proper payments. Ensure you employ or contract with billers who
possess ASC-specific billing expertise, including billing multiple payer
types and insurance plans. You will also want to ensure these billers
remain current on payer rule changes, which typically occur at least annually.
If a rule change occurs that affects one of your procedures and/or specialties
and your biller(s) is unaware of the revision, denials are likely to follow
or you may miss new billing opportunities.
2. Eligibility, verification, and authorization
Inaccurate patient insurance information can significantly disrupt an efficient
collections process. Ensure your staff consistently perform eligibility,
benefits verification, and proper authorizations. Staff should never assume
a patient's insurance details are current. Technology is available
that allows staff to essentially perform real-time verification of insurance
information and determine coverage. Such a solution often estimates a
patient's financial responsibility, which can help improve upfront
collections and compliance with surprise billing rules.
3. Days to dictate
Any delays in the completion of dictation stalls the completion of the
functions that follow, which will delay claim submission. If you observe
an increase in days to dictate, speak with the responsible provider about
what they require for timelier dictation. Investing in solutions that
can expedite dictation and transcription may be worthwhile. These include
apps providers can use to dictate, review, edit, and electronically sign
operative reports on their mobile device.
4. Inaccurate and incomplete operative notes
When an operative note has inaccurate or incomplete billable information,
delays in claim submission and increases in denials are more likely to
occur. Consider supplying your physicians with the aforementioned technology
and provide education about the information required for complete operative
notes. Additionally, ensure your coders, billers, or coding company can
recognize poor documentation so they can catch and then quickly resolve
discrepancies or insufficient information.
The Bottom Line (for a Healthier Bottom Line)
ASCs that want to achieve a healthy bottom line must ensure all functions
and elements of the revenue cycle receive appropriate attention —
not just those that may seem like the most important.