ASC Revenue Cycle Fixes: Q&A With Jocelyn Gaddie & Billie Reese-Turner of in2itive Business Solutions

Jocelyn Gaddie is the vice president of business development and Billie Reese-Turner is the director of client services for Overland Park, Kan.-based in2itive Business Solutions.

Jocelyn Gaddie, vice president of business development, in2itive Business SolutionsMs. Gaddie creates new billing service opportunities and builds existing partnerships for the business. She has more than eight years of sales and development experience in the healthcare industry, including extensive sales in the field of medical equipment.

Ms. Reese-Turner has 11 years of experience in ASC billing including insurance verification, charge entry, payment posting and accounts receivable follow up; training employees and implementing new procedures and processes. She is responsible for the transition and implementation of new clients for both full-service contracts as well as temporary and special projects. Ms. Reese-Turner brings more than 16 years of experience in the health insurance industry, as well.

Here they discuss tactics for improving both patient collections and overall revenue cycle management.

Question: How big of a role do patient collections play in a center's overall profitability?

Jocelyn Gaddie: Patient collections play a tremendous role in a center's overall profitability. Every center wants to have patients who pay their bills. It's those patients who pay in a timely manner that you want as repeat customers. It's also very important that facilities have a comprehensive policy in place that ensures that patients who have surgery at your ASC will pay for those services in full whether that is through insurance or self-pay.

Billie Reese-Turner: Another opportunity for revenue at a facility is an in- and out-of-network match of a patient's in-network benefits.

Q: What can ASCs do to improve patient collections?

JG: ASCs can improve patient collections by verifying and authorizing patient’s benefits ahead of time. This allows the facility to let patients know what is due before the time of service. It’s also beneficial to collect the patient’s deductible and insurance on the day of service.

Billie Reese-Turner, director of client services, in2itive Business Solutions. BRT: From an administrative side, it’s critical to have all information coded and billed accurately to the correct insurance company, specific to the insurance company's requirements. Little things like incorrect input of demographic data or an incorrect code can slow down a payment on a claim.

JG: Facilities that offer multiple payment plans (cash, credit, check and third-party payment plans) allow a center to receive their money in full, and then it becomes the responsibility of the patient to make payments to third-party operator such as Care Credit.

Collectors should always send three statements (first, reminder and final) and are not afraid to call and ask for money owed before it is moved to collections. There should be a clear policy of what a patient is allowed to pay on a monthly basis. Some [centers] offer policies that allow consistent pay within six months, but ultimately it's most beneficial to receive three payments in 90 days. Facilities that do the best on collections rarely go past 90 days. 

Q: What other areas pose the biggest threat to revenue and profits? How can these threats be managed and overcome?

JG: Delays caused by the entry of incorrect information and improperly loaded contracts are a tremendous threat to revenue and profits. In this business, time is literally money. By making sure information is entered correctly on the front end and ensuring that contracts are loaded properly, you'll know what should be collected and if the obligation is being met by the insurance carrier. If information is loaded or entered incorrectly the facility won't be paid correctly or in a timely manner.

BRT: These things can be easily overcome with a yearly review of contracts to ensure they are loaded properly. Also consider implementing a comprehensive system of checks and balances among the charge entry person, payment poster and revenue cycle manager or collector. This serves as a double check that things are coded correctly, entered correctly by each contract and that denials are promptly resolved. With this kind of comprehensive communication it is less likely that revenue will be missed or delayed.

Q: What are some general best practices for improving billing and collections?

JG & BRT: Teamwork, staff coordination and solid best practices

Q: What suggestions do you have for getting claims out the door more quickly?

BRT: In the current environment, it’s critical that billing offices stay up-to-date with CPT, ICD-9, ICD-10 and changing Medicare NOC (Not Otherwise Classified) descriptions. Each person within the billing office serves a highly complex role that is dependent on teamwork and timeliness. Ideally, in 48 hours or less a claim is dictated, reviewed and coded with procedure and diagnosis codes according to payor specifics. Efficiency and accuracy are incredibly important because once a report is coded; the clock begins ticking on the claim.

Q: Do you expect revenue cycle processes to change for centers in the next year? How so?

JG: Revenue cycle processes will extensively change over the next year because of the implementation of ICD-10 in Oct. 2014. These ICD-10 changes in will affect doctors, insurance carriers, software systems and clearinghouses for electronic claim submissions. Everything will need to change to accept these new codes and it will require a lot of preparation, including updates of all software systems, education on how to use the new codes, and updates by insurance companies on how to interpret diagnoses and conditions.

Q: What should centers look for in an outsourced billing office?

JG: Current on coding changes and billing software; formalized appeals process; denial tracking and trending; established tracking of key indicators; continuing staff education; strong relationships and contacts within the billing industry; knowledge of insurance follow-up resources; and detail-oriented and cross-trained staff members.

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