4 Proven Tips to Maximize Reimbursement in Surgery Centers

Michelle PunshonMichelle Punshon is the administrative director of Musculoskeletal Ambulatory Surgery Centers at Coastal Orthopedics & Sports Medicine in Bradenton, Fla. When she first came to the Coastal Orthopedics & Sports Medicine surgery centers she focused on maximizing reimbursement to increase net revenue. Here she shares tips for ambulatory surgery center leaders looking to do the same.

1. Properly utilize computerized practice management systems. Many surgery centers are currently using or making the switch to a computerized practice management system. A computerized system can streamline the entire reimbursement process, but only if a surgery center's contracts are correctly uploaded into the system. Eliminating the errors caused by incorrectly uploaded contracts is one of the most important steps ambulatory surgery center leaders can take to receive the highest possible reimbursement.

A properly utilized system will help ASC staff keep track of the reimbursement process. "You will know the amount you should be receiving from an insurance company. If your payer contracts are loaded correctly, the contractual adjustments will be taken from the total billed, which would leave the balance expected from the insurance company. The check should match. If there is an over or underpayment, it will be noted when the insurance payment is posted," says Ms. Punshon.

2. Educate physicians on the cost of cases. Reimbursement is in part reliant on case mix. Some cases reliably yield high reimbursement in ambulatory surgery centers, while others do not. For example, many contracts do not reimburse for implants. ASC administrators should educate physicians on the cost of cases and what the center is being reimbursed. "We need to be proactive in letting physicians know this. They can then make an informed decision on whether or not they perform a particular case in the center," says Ms. Punshon.

3. Ensure that the right staff is place. There is a potential for the loss of revenue if a surgery center does not file claims in a timely manner or doesn't dispute claims on time. The best way to avoid these oversights is by placing the right people in the right place. At Ms. Punshon's surgery center, one staff member oversees collections, one oversees billing and one oversees posting. The correct staff will ensure that the accurate reimbursement is received and the opportunity to correct any payer error is not missed.  

4. Continuously follow up with payers. Surgery center staff needs to always be prepared to work on denied and zero pay claims. Run an aging report through the practice management system and look for account balances past the 90 day mark. "See what has not been paid, even though it has been filed or billed. Either electronically or by mail, an insurance company may not have received the claim," says Ms. Punshon.

Contact the payer to check if the claim was received. If the reimbursement amount is not correct, tell the insurance company about the underpayment or discrepancy. ASC staff should actively pursue these issues. "It takes persistence, but insurance companies are willing to work with us," says Ms. Punshon.

More Articles on ASC Issues:
The Power of the Checklist: 5 Steps for Surgery Centers to Always be Accreditation Ready
7 Key Financial Metrics at Surgery Centers
5 Strategies to Improve Surgeon OR Communication With Anesthesiologists

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