ASC Forensic Collections: Unearthing Hidden Treasures

The following article was written by Carol Ciluffo, vice president of revenue cycle management for Pinnacle III. Learn more about Pinnacle III.

It doesn't matter where you stand on the ongoing health care debate; the unavoidable fact is healthcare providers must continue to pare down costs without sacrificing quality. Creating efficiencies while simultaneously adhering to regulatory mandates is a challenge every ASC must successfully navigate to ensure the center’s future viability. Wouldn’t it be nice to unearth a hidden treasure in your search for a sustainable profit margin?    

High-quality care is practically a given in the ASC industry, but capturing every dollar the ASC is owed is not. If you suspect money is being left on the table, it may behoove you to outsource your coding, billing and collections or retain the services of a new revenue cycle management company.

When a revenue cycle management company assumes responsibility for your existing accounts receivable, they should begin by performing a forensic collections analysis — digging below the surface to ascertain which actions did, or did not, occur that led to the concerns being faced today. Analyzing the patient accounting system set up, reviewing the existing charge master, and thoroughly examining the aging are essential components of the process.

A patient accounting system that is not set up properly is inefficient and ineffective. If contracts are not loaded into the system, it is difficult to determine at time of posting whether or not a claim has been processed correctly. Additionally, using an outdated charge master can lead to a payor with a "lesser of" contract clause remitting a much lower dollar amount than you were entitled to according to their fee schedule.

An inquiring mind and critical thinking skills are necessary to dissect an aging. When were accounts last billed? Is documentation available to determine why account balances are outstanding? Is it necessary to drop claims a second time to avoid timely filing penalties? Were secondary payors billed? Did patient balances get transferred properly and were they billed to the guarantor timely? How often were patient statements generated and when were they last dropped? Have denials been properly investigated? Were appeals filed?   

Finding "old" money is an arduous time-consuming process, but the result could net significant revenue for your ASC. Align yourself with a revenue cycle management partner who not only provides you with the "obvious" services but is also willing to expend the time and energy necessary to stake claim to the maximum reimbursement owed to you. Additional money can be found in the strangest places — leave no stone unturned when you embark on this treasure hunt.

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