1. Perfect the pre-admission process. Ms. Semanyshyn recommends you prepare a form with a checklist of items needed to ensure coverage and proper billing. “Do not rely on corrections being made on the back end of the revenue cycle,” she says. If your billing team has all the proper information before the procedure, your ASC will enjoy quicker payments and no threat of denial due to untimely filing or missed appeal deadlines.
2. Attain the necessary referrals and pre-certifications for the correct procedure and the correct date of services.
3. Always obtain a copy of the patient’s insurance card.
4. Make sure your demographics sheet is completely and properly filled out each time the patient visits your ASC.
5. Verify Medicare eligibility. Ms. Semanyshyn says all too often you will find the patient has a Medicare replacement plan, meaning the patient has signed over his or her Medicare benefits to the replacement plan and does not retain the original Medicare plan during the period of enrollment. Medicare replacement plans, or Medicare Part C, cover many services offered through original Medicare plan but not all of them.
6. Be vigilant about collecting information for workers’ compensation and motor vehicle accident cases. For WC and MVA, Ms. Semanyshyn recommends acquiring the claim number, date of accident, carrier name and address, adjustor’s name and contact information and claims address before the procedure. “Collecting this information after the fact will be difficult,” she says.
7. Check your EDI reports daily. If your EDI reports contain errors, you want to be able to fix them as soon as possible. If your staff finds a mistake, “make corrections and resubmit the claims the same day whenever possible,” Ms. Semanyshyn says.
8. Address correspondence the day it arrives.
9. Immediately address denials on your daily EOBs.
10. Promptly provide the carrier with the operative notes requested for processing your claim. As with other tips for maintaining a healthy AR, promptness is key in providing your carrier with requested op notes, Ms. Semanyshyn says. Involve your physicians in submitting op notes in a timely fashion so you can submit the necessary information for your claim as soon as possible.
11. Train your staff in coding changes and changes in carrier requirements. Ms. Semanyshyn points out each carrier has different requirements that may change on a regular basis. “Each carrier has different requirements for pre-certification, claim submission, corrected claims, timely filing and timely appeal limitations,” she says. “Keep a spreadsheet and update changes.” The same diligence is necessary to alert your staff of coding changes: make sure your staff is provided with the necessary education to keep up-to-date.
12. Follow up on A/R the old-fashioned way. While ASCs should use the best technology and software available for billing, claim submission and document storage, Ms. Semanyshyn says A/R follow-ups should be done over the phone. “Have a dedicated staff directly accountable for unpaid claims,” she says. “Pick up the phone and call the carriers and find out why your claim is not paying.” She says a responsible billing staff should follow up on every claim at least once a month. “Next to verification of benefits, this is the most important step in the revenue cycle and it is very often the one process that is always unstaffed,” she says.
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