Ambulatory surgery centers must implement strict protocols and procedures to ensure payment from patients and reimbursement from payers amid an increasingly complex billing environment.
During the Becker's ASC Review 24th Annual Meeting: The Business and Operations of ASCs Oct. 26 in Chicago, three revenue cycle experts shared their thoughts on how ASCs can improve reimbursements. Panelists included Lisa Rock, president of Chesterfield, Mo.-based National Medical Billing Services; I. Naya Kehayes, principal at Atlanta-based ECG Management Consultants; and Jasmine Gonzalez, billing manager for Manhattan Surgery Center in New York City.
Ms. Kehayes highlighted the complexity of today's reimbursement processes for ASCs, saying no two payers reimburse surgery centers the same way. To optimize revenue from payers amid such a variable billing system, Ms. Kehayes said it's crucial for ASC leaders to understand not only the reimbursement system and payment method, but also the difference in their products and benefit designs. "As those benefit designs continue to change, it's becoming more important to understand your upfront collections and realize more of it is coming from the patient," she said.
Education is a huge piece of the reimbursement puzzle, especially as collections move from back-end processes to the front, according to Ms. Gonzalez. She said front-end staff must understand their center's contracts and know what types of patients are walking through their doors.
"At the verification level, it's very important for staff to understand what products we participate with, what percentage they pay, what procedure codes are covered, etc.," said Ms. Gonzalez. "Bringing the contract all the way to the front level is very difficult, but important to do."
Ms. Rock estimated that 20 to 30 percent of a center's paycheck today comes from patients as the payer, which strengthens the need to have a strict collections process.
"Ten years ago, I'd say we should collect 95 percent of net revenue and leave 5 percent for bad debt," said Ms. Rock. "That is not the case today … If you need to collect 40 percent [of charges] from the patient, and you can get them to come through the door, you're very lucky."
To ensure proper reimbursement, Ms. Rock stressed the importance of ASC leaders knowing their center's net revenue in relation to their collection rate. "You should be asking yourself, 'I'm collecting 95 percent of what?' It's that 'of what' ASCs should be focusing on today. If you don't know what your net revenue is supposed to be, nothing else matters," she said.