ASC RCM Quick Tips: Improve 4 Overlooked Elements of the ASC Revenue Cycle
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 performance.
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.