1. Verify benefits. Don’t assume prior to surgery that your patient understands how his or her insurance works, Ms. Berreth says. “[Patients] just assume that their insurance is going to pay for this, and they don’t understand that if they have an 80/20 insurance plan, they’re going to owe 20 percent of a bill that [can total in the thousands].” Before your patient arrives at the center, call them to make sure they understand how their insurance plan works and they have the benefits they say they do.
“Every third-party payor has its own fee schedule, and the key is helping your patient understand the process of being billed from a surgery center,” Ms. Berreth says. She says that in order to make the process smoother for your center and the patient, you can spend some time going over the payment process. “Before a patient asks anything, you can ask, ‘Do you understand you’re going to be paying a portion of this?'” Ms. Berreth says. “Depend on verbal communication, because so many people can’t read information and absorb it when they’re frightened or anxious.”
2. Hire a certified coder. Even if you’re trying to cut costs by consolidating your staff, don’t give someone primary coding responsibilities if he or she is not a certified coder. “You don’t want somebody like me coding all the time,” Ms. Berreth says. “I don’t catch the nuances a certified coder would catch.” She adds that it’s not enough to hire a certified coder and assume your work is over. Instead, make sure your coder is constantly seeking out education opportunities to learn more about the subject, whether through webinars, coding conferences or keeping up with coding news. “They’re the ones who are going to make or break your system by catching the operative report that’s not dictated properly,” she says. “They’re going to catch mistakes where the physician said he performed a procedure but didn’t document it.”
3. Create a system of checks and balances. Ms. Berreth says your coding, billing and collections work should be split up among a team of people. This can be more difficult for a smaller ASC, but having a team can prevent one person’s mistakes from causing major problems for your center. “My biller and my coder are also involved in collections, and between the two of them, they can do cross checks,” she says. “They can look at claims and figure out why they were denied — was the modifier wrong? Was the CPT code wrong?” She says by staffing only one person on billing, coding and collections, your ASC can miss denied claims or unpaid bills and not even realize you’re losing money.
4. Follow up with patients who haven’t paid. Whether your requirement payments to be made in one installation or you accept payment plans that let patients pay their bill in portions, you need to make sure you know the status of every patient and every payment, Ms. Berreth says. Sixty days after the third-party payor has paid their portion of the bill, you should call patients to investigate why they haven’t paid. “My collector can be like a dog with a bone,” Ms. Berreth says. “She is very diligent about calling, and she has a list of people she calls on an almost daily basis.” You might feel guilty for bothering people about money — especially when so many people are unable to pay their bills — but remember that you deserve to be paid for procedures, and sometimes you might be dealing with a patient who just needs to talk through their bill with an expert.
