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4 thoughts on the ins & outs of ASC revenue cycle management

ASC revenue cycle management can be a challenge, as ASCs are lean organizations, managing many aspects of the revenue cycle in-house.

At the Becker's 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference, June 14 to 16, in Chicago, Ethne Nance, revenue cycle analyst/ICD-10 trainer at Seattle-based Pacific Medical Centers, and Kylie Kaczor, MSN-RN, vice president of clinical and regulatory affairs at National Medical Billing Services, weighed in on the complexities of ASC revenue cycle management as well as strategies to improve the processes.

Here are four thoughts from the discussion:

1. Ms. Kaczor on the impact of new healthcare legislation: "The current administration is heavily focused on healthcare reform and has been since the campaign where they promoted a full repeal and replace of the Affordable Care Act. Although they haven't done a full repeal and replace at this time, they are addressing certain parts of the legislation piece by piece and we can only expect that to continue. The government is also very focused on cutting costs, and because of this there is a lot of attention on ASCs. We all know that ASCs provide high-quality care in a low-cost setting, so there is a lot of attention on what procedures can be and should be performed in ASCs. Increasingly, states are also making changes by enacting balance billing or surprise billing legislation. We are fast approaching nearly 30 states that have some form of this legislation with some legislation being more comprehensive, while other legislation addressing only single components. We expect this trend to continue. We know that high deductible health plans have been on the rise, and in these scenarios, patients are treated at an in-network facility. However, increasingly, patients are treated unknowingly by an out-of-network provider and receive large patient responsibility statements after receiving care. As a result, the states are taking it upon themselves to protect the consumer with this legislation, therefore it is important to understand this law in your state to ensure you are compliant in your collection of patient responsibility."

2. Ms. Nance on regulatory changes: "What I am seeing across the country in ASCs is that people are overwhelmed and do not understand the specific regulatory changes and guideline changes. Everyone is getting buried in unnecessary denials. I always refer to it as death by papercuts. It's not one specific thing that's putting a stop to your RCM, it's a thousand different things. From experience, I've seen that front-line administrative staff, including coders, billers, receptionists, are the lowest paid and the least trained or experienced. So if you want to improve RCM or billing, they are the people who need the most training, because they are the ones fielding the changes."

3. Ms. Kaczor on physician documentation: "One of the areas relative to coding that gets overlooked all too frequently is physician documentation. We all know 'If it wasn't documented, then it wasn't done.' If physicians or administrators are not giving the coders the level of specificity needed in your operative reports to get the claim out the door, then there will be delays in submitting claims and subsequently getting paid on those claims."

4. Ms. Nance on out-of-network billing: "Within a facility or practice, handling out-of-network cases, you have to be proactive. Have solid processes. You have to do a lot of work on the front end and you have to have staff who can understand which deductible applies. Your staff has to be very disciplined to check for the benefits and to understand which codes apply for [a particular] type of surgery. Try and get paid upfront. [With out-of-network billing] your A/R starts before you see the patient."

More articles on coding, billing and collections:
Billing tip of the day: Remember these 3 rules when billing Medicare for IOLs
Maximize your 2018 reimbursements: Know your health plans, know your market, and stay on top of trends
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