By Angela Mattioda, Sr. Vice President of RCM Solutions & Client Experience
Want to make 2023 your ambulatory surgery center's best financial year
yet? Take these 10 revenue cycle management (RCM) steps and watch your
bottom line grow!
1. Touch critical RCM processes daily. Ensure staff members work on denials, correspondence, and medical record
requests daily. Working claims and denials in a timely fashion will help
you achieve more consistent cash flow and prevent revenue leakage caused
by timely filing denials.
2. Improve your days to dictate KPI. Delays in the completion of dictation stall the completion of the functions
that follow, which will delay claim submission and collections. If you
observe an increase in your ASC's days to dictate key performance
indicator (KPI) or you are not where you want this metric to be (standard benchmark is one day, with dictation preferably completed the same day as the case
is performed), speak with the responsible provider(s) about what they
require for timelier dictation. Investing in solutions that can expedite
dictation and transcription is often worthwhile. These include apps providers
can use to dictate, review, edit, and electronically sign operative reports
on their mobile devices.
3. Closely monitor operative notes. Ask your ASC's revenue cycle management company or in-house billing
manager to provide ongoing monitoring of operative notes, identifying
when they lack the necessary level of detail. Using this information,
provide feedback and education to your staff and surgeons to help ensure
no money is left on the table or wasted due to op notes lacking the highest
level of specificity.
4. Prioritize pre-procedure collections. Don't wait to collect from your patients until after their procedure.
It's best practice to collect the estimated amount before or at the
time of service. Why? It's much easier to issue a refund than collect
on the backend.
5. Immediately update authorizations when a scheduled code is changed. To reduce your ASC's likelihood of denials, ensure authorizations are
immediately updated if there is a change from the scheduled code(s). Track
these changes to provide the scheduling physician's office with feedback
on the incorrect code(s) if such changes become regular occurrences.
6. Don't verify benefits too early. If you use patient estimation software, it is a good practice to set it
up to verify benefits 1-2 days prior to service. This will better ensure
you have the most updated information, which can help reduce the number
of refunds you must process each month.
7. Individualize appeals. When submitting an appeal, individualize it to the patient and case to
increase the likelihood that you are successful. While it's acceptable
— and best practice — to develop standardized appeal templates
to help expedite appeals, each appeal should be specific to the patient
and denial reason(s).
Report authorization numbers on claims. Even when a case is properly authorized, there can be denials that delay
cash flow. Best practice is to include authorization numbers on claims
to help avoid delays with unnecessary denials.
Note: Obtaining an authorization does not guarantee payment. There could be clinical
policy requirements that must also be met. Providing these requirements
to the physician is a vital part of ensuring successful and complete collections.
9. Give bad debt adequate attention. Track and report metrics to your board pertaining to historical collections
cases and the amount your ASC is a losing each month to bad debt. If the
bad debt seems high, it should be looked at closely to determine the reason(s).
The data can also be used to help make improvements to your ASC's
front-end collection process.
10. Don't wait for implant invoices.
A big challenge for ASCs that perform procedures requiring implants is
when carriers require implant invoices to process and reimburse claims.
Typically, device vendors submit their invoices 2 to 4 weeks following
the service date. Do not delay claim submission until you receive this
invoice. Rather, calculate the implant cost using the purchase order and
the claim submitted for processing. Taking this approach will decrease
the likelihood that your ASC will encounter timely filing denials.