Back to the Basics: Overcoming Key Challenges in Billing and Collections at ASCs
Ms. Rock said the first step to improving billing and collections is starting at the beginning: ensuring insurance verification, registration accuracy, collection of co-pays/co-insurances and deductibles at time of service, COB forms and knowledge of a facility's error rate. ASCs should also maintain a goal of getting 95 percent of claims to the carrier within 24 hours.
Ms. Rock discussed tough issues ASC must overcome, such as utilization of the National Correct Coding Initiative, understanding of carriers' codes, claims match, missing information and unbilled reports. Other key considerations include the following:
Correct cash posting is critical. The role of the first responder is crucial, as they identify incorrect payments and log denials and zero pays. They control a large range of processes, including cash posting, system balancing, denial management and follow up.
Managed care contracts are one of the most important things ASCs should focus on today. Things to consider are EDI and EFT requirements, reimbursement methodology, rates and implants, multiple procedures and most favored nations clause.
ASCs must set collection goals. They must be based on case mix, payor mix, days in A/R, net revenue as a percent of gross charges and more. "You as ASC managers have to look under the hood and give your coders realistic expectations," Ms. Rock said.
Ms. Rock added ASCs must pay heightened attention to common reasons for denials, take backs and out of network reimbursement. Several best practices, such as an electronic insurance verification benefits solution, measure performance and accurate statements and reports, can facilitate a more fluid and efficient billing and coding process.
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