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Insourcing, outsourcing & the 'golden rule' of billing — Surgical Notes RCM VP Angela Mattioda breaks down ASC billing practices

Billing is one of the most important aspects of any practice, big or small.

ASCs, however, present a unique challenge. Becker's ASC Review spoke to Surgical Notes RCM Vice President of Revenue Cycle Management Services Angela Mattioda about in-house and outsourced billing, common billing mistakes and the 'golden rule' of medical billing.

Note: This has been lightly edited for style and clarity.

Question: If an ASC was looking to improve its in-house billing operations, what's a best practice that has worked for Surgical Notes RCM that an ASC could consider? 

Angela Mattioda: One practice we find extremely helpful for our clients is the close monitoring of productivity [trends] and key performance metrics as a means to identify potential issues immediately. It’s worthwhile to invest in a solid business intelligence analytic solution to ensure accurate monitoring of all metrics.

Q: If an ASC is looking to outsource its billing and collections, what should it look for in a partner? What are the benefits to outsourcing billing? 

AM: The benefits to outsourcing align with the qualities you should look for in a revenue cycle management partner. The revenue cycle management company should have specific experience working with ASCs. Its coders should be certified and have extensive experience with your facility’s specialties. Billing and collections should never be outsourced overseas. The ASC should look for a “business partner” that focuses on quality and is staffed appropriately to ensure all accounts are worked [on in a] timely and aggressively [manner]. The RCM company should also have a broad knowledge of all payer types.

There are many other qualities an ASC will want to look for in an RCM partner, but those listed here represent some of the most essential. Surgery centers should perform their due diligence in order to make an informed decision.  

There are numerous benefits that come with outsourcing your RCM. Here are just a few of them:

  • Experienced operations manager to closely monitor all facets of the RCM process
  • Experience with negotiating and filing strong appeals
  • Knowledge of escalating difficult cases
  • Assistance with preparing board reports
  • Professionals to provide feedback on front office process and patient collection practices
  • ASC-certified billers and coders
  • Payment posters who post correctly per the explanation of benefits and recognize incorrect payments
  • Reconciliation of all charges and payments
  • Expert handling of all denials
  • Handles all submissions, resubmissions and rejections
  • Managed care contracting assistance
  • Monitoring of changes in government regulations
  • Claims and analytics software

Note, not every RCM company offers the personnel, services and solutions noted above — one more reason to make sure you do your due diligence!

Q: What are some common billing mistakes that are easily preventable? 

AM: One common billing mistake typically revolves around specific state/payer regulations and requirements. Rules concerning use of modifiers, unbundling and HCPCS versus CPT code selection can change depending on the payer and the ASC's state.

Another common mistake is not thoroughly verifying benefits and receiving the appropriate authorizations. A provider may anticipate performing a specific procedure, but as the surgery progresses, that CPT code could change. When this happens, it’s critical to add the new CPT code to the authorization immediately to avoid any denials and delay in payment.

For additional tips, review a recent article published in Becker’s ASC Review titled "Avoiding 10 common billing mistakes that slow the ASC revenue cycle."

Q: What's the "golden rule" of billing? What should every person working in billing know at all times? 

AM: Billing for an ASC is different than any other type of medical billing. It’s very important to make sure the person performing the billing has extensive knowledge specific to ASCs. The biller should understand medical necessity requirements to avoid denials down the road that can lead to loss of income. These requirements, which vary from payer to payer, need to be communicated to the provider to ensure all bases are covered and the dictation is detailed.

The “golden rule” boils down to one critical concept: communication! The biller should communicate with the provider, front office staff completing the insurance verification and authorization, and the collections team.

 

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