Pain management can be a productive addition to an ASC. However, due to the high volume nature of the specialty and the nearly 47 million uninsured Americans, an experienced and determined billing and collection department is essential to the success of any ASC which performs pain management.
Develop a successful billing and collection process
Whether you are trying to predict the effect of healthcare reform on your business, or fighting for reimbursement dollars from payors and Medicare, there are billing and collection guidelines and processes that can greatly enhance your facility’s overall success rate. The foundations for a successful pain management billing and collection process are comprised of the following eight elements.
1. Charge entry dates. The date a certain activity takes place is important. You should be checking the date of services on an account against the posting date (time between a charge is generated and when it is put into the practice system). Office charges should have the same date and as little lag time as possible between the two. Hospital charges are a different matter: If the physician does not report the charges timely, then staff cannot post them into the system. This creates substantial lag time, slowing down the reimbursement process and negatively impacting cash flow. Hospital charges should be reported daily. Online, smart phone and other technology can allow physicians to send patient contact data and charges essentially in real time. Consistency in charge capture and reporting is a very important step to greater efficiency in your department.
2. Claim file date. Make sure that claims are filed and transmitted daily. Daily transmission enhances cash flow.
3. Reviewing aging analysis report. This report shows how much is owed to the ASC and remains outstanding. This report should be composed and reviewed monthly. Working this report monthly allows you to know immediately of any billing or collection issues that could affect your cash flow.
4. Insurance verification. Patients’ insurance should be verified before every visit to ensure the patient continues to have active coverage. If the patient doesn’t have active coverage, this allows you to collect payment up front or set up payment arrangements at the time of appointment. Policies should be in place to collect all co-pays at the time of service.
5. Contracts. Your billing department staff members must have a strong understanding of your current reimbursement contracts. This guarantees they are up to date with what procedures are allowed and ensures they have a working understanding of every carrier coding guidelines and requirements to assure prompt reimbursement. Having a positive relationship with payors, and an understanding of their preferred billing practices, goes a long way in speeding up the reimbursement process. Add additional information on mechanisms to manage and communicate medical review policy to physicians so they do not find themselves in a situation of performing a procedure they cannot get paid for. Also review CCI edits information.
6. Procedure pre-determination. All procedures need to be reviewed in advance to verify if a pre-determination is needed prior to the procedure being performed.
7. Review EOBs. This allows you to know claims are getting paid or denied and alerts the department to potential coding issue. Staff should also have access to a current fee schedule to make sure your department is receiving correct reimbursements per your contracts.
8. Mechanisms to track encounters to ensure no visit to an office, ASC or hospital goes un-billed. The billing and collection office generates encounter forms which produce a ticket number for every visit completed in the office, ASC or hospital to ensure all charges are captured. Once dailychargeshave been entered, a missing ticket report should be run that will account for any missing encounters. When rounds are completed at the hospital, the provider utilizes a rounding sheet that is tracked by a designated person in the office to ensure that daily rounding information is received and billed timely.
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