In a webinar hosted by Becker's ASC Review on Feb. 24, Liz Taylor, ambulatory surgery center operations manager and Clint Hughes, vice president of marketing, at MediGain, discussed ways ASCs can increase their out-of-network revenue.
It is a fallacy to believe that revenue cycle management deals only with the coding, billing and collecting after the procedure is complete. "Revenue cycle management process begins at the time a surgeon's office calls to schedule a surgery," says Ms. Taylor. "The surgery center needs to gather all pertinent data to make an informed decision on whether or not to do the case."
Here are four tips for increasing out-of-network revenue at ASCs:
1. Make sure a verification of benefits is completed. According to Ms. Taylor, verification of benefits is a standard process when considering an OON case, and should be performed within 24 hours of the surgeon's office calling to schedule the procedure. "This will ensure that patients are notified of their responsibilities in a timely manner," says Ms. Taylor.
Also, it is important to complete this process before the decision is made to take on the case so that the ASC staff can make an informed decision. Once the patient's financial responsibility is calculated, the center's staff can then estimate how much the insurance company will be paying and then the staff will be able to see if the case makes financial sense.
2. Collect up-front from the patient. "The best way to collect payment from patients is up-front and as early as possible," says Ms. Taylor. Once the decision has been made to perform the case, call the patient and let them know what they owe. Try and call patients well in advance and not the day before the surgery.
Also, offer different payment options so that patients have flexibility with regard to payment. If you are able to offer in-house payment plans or credit plans, there will likely be fewer cancellations, notes Ms. Taylor.
3. Keep an eye on collector and payment poster responsibilities. Getting paid, and getting paid appropriately, from OON cases depends on collectors and payment posters doing their jobs well. It is important that collectors gather all information needed on the phone call with the insurance company to get a head start on the reconsideration process. Also, they must negotiate. "Remember that the case is out-of-network and so never accept the first negotiation," says Ms. Taylor. "Ask questions and review previous data to confirm the allowable."
Both the collector and payment poster must be adept at reading and analyzing the explanation of benefits. The EOB can be misleading, according to Ms. Taylor, and the payment poster must be able to determine the correct allowable. Also, the payment poster can read and review the collector's notes to ensure that they are capturing additional revenue.
4. Keep the business office involved. Communicating with the business office and giving them all the resources they need is key to increasing OON revenue. Ask yourself if your medical billers have the information they need and if the business office is filing claims in a timely manner, says Ms. Taylor. Ensure that physicians are getting all the paperwork from their end done within 24 hours to 48 hours so that claims can be pushed out. "Educate members of your business office and make them a part of the process," she says.
Download the webinar presentation slides here.
View the webinar by clicking here.
We suggest you download the video to your computer before viewing to ensure better quality. If you have problems viewing the video, which is in Windows Media Video format, you can use a program like VLC media player, free for download here.
Note: View archived webinars by clicking here.