If an ASC works with a billing services company, strengthening that relationship is essential for maximum reimbursement.
"You really need to have the fundamentals in place to maximize all of the moneys coming in between you and your billing services company, and that starts with having a top tier ASC management system," Robert Romero, vice president of business development at MediGain, said at the Becker's ASC Review 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago.
Mr. Romero outlined six best practices to improve the ASC management system, strengthen relations with the billing services company and attain higher reimbursement.
1. Fully define the scope of services for your billing company. From day one, ASCs need to define the scope of services and responsibilities of the billing services company, or those of the billing department if an ASC does this internally, according to Mr. Romero. The ASC management system should have a clear understanding of the billing services company's responsibilities, as well as their own to ensure billing runs smoothly and efficiently. This includes creating a detailed workflow map so the ASC management system can track any claim at any point. This is extremely important if the ASC must back-track due to an appeal.
2. Make sure you have a dedicated account manager. The billing services company should provide an ASC with an account manager.
"This should be a person you could call on their cell phone, someone who is knowledgeable about your facility because it's similar to a number of other facilities that they've worked on before," Mr. Romero said.
Additionally, the ASC should appoint a dedicated liaison to the billing services company. According to Mr. Romero, this person will probably not be an administrator or a physician, but someone in a clerical role with the capability to effectively translate important information from the ASC to the billing services company to answer questions at any point during the billing process.
3. Be fully transparent with EMR data. The billing company needs "unfettered access" to EMR data and other documented information related to billing, such as coding transcripts, according to Mr. Romero.
4. Enlist certified coders. ASCs should have a certified coder on staff, or bring in one from the billing company, who can ensure the surgeons' dictation and documentation fulfills the standards that coders need to avoid discrepancies that lead to appeals. Along the same lines, it is important to ensure a solid claim scrubbing process is in place — meaning patient insurance information is accurate and diagnosis and procedure codes and charges make logical sense.
5. Create a robust verification of benefits system. ASCs should train staff who work closely with patients — likely a benefits coordinator — to communicate with patients about their financial responsibilities and exactly what their insurance plans cover. This requires continual payer-specific training, according to Mr. Romero.
6. Check accounts receivable more frequently. According to Mr. Romero, ASCs' accounts receivable should be reviewed every 15 days, not every month. More frequent reviews, combined with increased collaboration on difficult appeals, can help ASCs identify and correct billing issues and reduce write-offs.