Every year, about one third of all Americans make at least one New Year's resolution in order to better themselves. Now that it's February, how far along are you in reaching your goals? In the spirit of always striving for improvement, here's a few tips that all ASCs should consider to improve financial success in 2016.
Get Healthy/Trim the Fat
What does it take to have a healthy accounts receivable? Based on gold standard metrics, a healthy A/R's percentage greater than 90 days is less than 15% for contracted facilities. One of the best ways to keep your % greater than 90 less than 15% is to focus on account follow-up. Claim status can be checked easily through a clearinghouse such as ZirMed, and ensure it is checked within five days of claim submission. Every outstanding account should be worked at least once every 30 days and accounts greater than 90 should be worked two to three times every 30 days.
Many ASCs have a bloated business office. According to data obtained from Regent facilities over the past 6 years, optimal business offices operate with 1.5 business office FTEs per 1,000 cases (for purposes of this study, business office FTEs include schedulers, insurance verifiers, medical records clerks, receptionists, BOMs, billers, collectors and payment posters). One way in which facilities can optimize business office staffing is by using ZirMed's online insurance verification, which produces a member's eligibility, benefits, copays, co-insurance and deductible information instantly.
In order not to procrastinate, one must not put off until tomorrow work that can be done today. Several areas which business office personnel should not procrastinate:
• Billing – claims should be billed at least once per day. This will help to keep a center's Charge Lag (date of service to charge entry) and Claim Lag (date of service to claim submission) to a minimum. There should also be no difference between your charge and claim lag. If there is, that means that biller is entering charges and waiting a period of time to drop claims. Remember every one day of claim/charge lag equals one day added to your Days Outstanding!
• Statements – though most patient statements are set to a 30 day cycle, the statements should still be sent a minimum of once per week. This ensures the Statement Lag (date of patient responsibility to statement sent) remains less than 5 business days. For efficiency, it is recommended to outsource statement production to a company such as ZirMed, which can often process and send the statements for less than most facilities can do it in-house
• Denials – when a facility's A/R is inflated, denied claims frequently account for many of the dollars sitting out over 90 days. That's why it's vitally important to follow-up with the insurance company immediately upon receiving a denial. Often a claim can be rebilled with simple modifications. If not, an appeal should be initiated without delay and followed-up on at least every thirty days
• Follow-up – you may often hear a facility is "leaving money on the table" which is another way of saying the facility is not collecting what's contractually theirs. This low Net Collection Rate is often the result of inconsistent follow-up. Not only should every account be touched a minimum of once every 30 days, but also followed through to some sort of resolution. It is important to set a clear definition of what "working an account" means.
Earn More Money/ Get out of Debt
The way to earn more money for the facility can be done in a variety of ways. You can recruit more doctors, introduce another specialty, expand your procedures, or renegotiate your contracts. This all involves a lot of work. A simpler way to increase cash is to focus on your business office processes:
• Code Correctly! Are all your procedures being coded correctly? You may be downcoding procedures and not even know about it. It often is worth the cost to outsource your coding to a certified ASC coding company who can help maximize your reimbursement
• Bill Correctly! Once procedures are coded, it is important for the biller to comprehend all the individual payer guidelines so the correct modifiers can be appended to the CPT codes. Incorrect modifiers can cost a facility hundreds of thousands of dollars per year
• Ensure Correct Payment! Most management information systems (MIS) today have the ability to upload payer contracts. This gives the payment poster the ability to determine whether or not the facility was paid correctly on contracted claims at the time of posting. If the payment is less than the contractual, the claim can be quickly rebilled or appealed if necessary
• Maximize OON Reimbursement! Payers will often use a third-party, incentivized on decreasing payments to providers, to help negotiate OON claims. Work to establish OON payment negotiating guidelines for your business office staff such as not to accept any offer of less than 80% of charges. All negotiations of less than 80% must be approved by the BOM in advance. Also consider partnering with a company such as CollectRX, who specializes in maximizing out-of-network reimbursement. The ROI is positive, since CollectRx only collects a percentage of additional reimbursement they bring to a facility
There's a lot of stress in running an ASC – clinical issues, compliance issues, board meetings, and ensuring financial success. Business office issues, if not handled properly, can take precious amounts of an administrator's time. Some of the more serious issues such as inconsistent follow-up may ultimately lead to the demise of the facility. One way to alleviate the stress of revenue cycle management (RCM) is to consider partnering with an industry-leading RCM partner with proven results. With today's technological advancements, an outsourced RCM employee working the center's account 1,500 miles away is just as effective as one sitting in the cubicle next door. These RCM experts will be 100% focused on the RCM for the facility and not disrupted by daily facility issues such as nurses forgetting their passwords or helping to fix the jammed copier (again!). This will allow administrators to focus on their number one priority, patient care.
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