5 Tips for ASCs to Optimize Accounts Receivable

Here are five tips for ambulatory surgery centers to optimize their accounts receivable process.

1. Track the number of days claims spend in A/R. Measuring the number of days it takes to collect on accounts receivable properly tells you if you have an A/R problem. If you suspect that you do, you must look at your internal systems that include timing of billing, post surgery collections and follow up, prior to surgery collections of copays and deductibles, follow up on denials. Alternately, it can be issues with insurance companies. "Use the statistic to dig deep and find out what is really occurring," says Mr. Zasa.

Accounts receivable aging can usually be tracked using the ASC's billing system, says Chance Sherer, manager with VMG Health. ASC billing systems are typically broken into groupings by days outstanding (0 to 30 days, 31 to 60 days, 61 to 90 days, etc.). While administrators do typically examine total accounts receivable and collections regularly, they may not examine aging of accounts or realize that this statistic can be benchmarked.

The typical benchmark utilized for comparison is the percentage of total accounts receivable in each period. For example, our 2011 Intellimarker reports that at the median, 53.6 percent of total accounts receivable are between 0-30 days outstanding. An administrator can use these metrics to examine the how efficiently the ASC is collecting compared to the industry. The higher the percentage of the subject ASC's accounts receivable in the 0 to 30 and 31 to 60 days periods compared to the 91 days plus periods, the better the ASC is collecting.

2. Perfect the pre-admission process. Daria Semanyshyn of Advanced Medical Practice Management recommends you prepare a form with a checklist of items needed to ensure coverage and proper billing. "Do not rely on corrections being made on the back end of the revenue cycle," she says. If your billing team has all the proper information before the procedure, your ASC will enjoy quicker payments and no threat of denial due to untimely filing or missed appeal deadlines. This means attaining the necessary referrals and pre-certifications for the correct procedure and the correct date of services, always obtaining a copy of the patient's insurance card and making sure your demographics sheet is completely and properly filled out each time the patient visits your ASC.

3. Collect more from patients upfront. ASCs want to collect more from patients before surgery, which is crucial. The chances of getting paid decrease every day you wait after surgery is performed. Patient collections are getting more important because deductibles are rising. The patient is now paying a larger proportion of the bill. Also, more patients do not have coverage, meaning ASCs increasingly have to ask patients for payment of the full bill.

The day after the case is scheduled, have your staff contacts the patient and reviews the expected payments. Give patients as much information as possible on what they would owe. This means first contacting the payor to verify coverage, specifying the amount of the patient's deductible and coinsurance, and determining how much of the deductible has been used. You can get a pretty accurate figure, although you still have to tell the patient this is still just an estimate. The surgery may turn out to be different than expected, making the bill higher or lower. Despite the lack of total clarity, it's still important to share a projected amount with patients before surgery, so that they can have an understanding. If you don't have this conversation, they are simply not going to think about it. In their way of thinking — sad but true — the medical bill gets paid after cable TV bill and the sofa purchase. When the ASC bill arrives, they might just ignore it. It's important for patients to pay a portion of the bill upfront and get a commitment from them to pay the rest.

4. Institute a policy for handling patients who struggle to pay. According to Michael Orseno, revenue cycle director for Regent Surgical Health, the ASC's policy should be applied to any patient claiming indigence, and include discounts based on the Federal Poverty Standards put out yearly by the U.S. Department of Health and Human Services.

"An alternative to patients who don't qualify for charity care but are having difficulty paying their out-of-pocket costs is to offer financing through a third-party financing company," says Mr. Orseno. "One such company, CareCredit, offers patients interest-free financing with six, twelve, and eighteen month plans. The cost to the facility is marginal, and is easily offset by savings in staff collection costs and time value of money. The center will receive payment in full, within two business days wired directly to their bank account." He says in these situations, the financing company usually assumes all the risk, so the ASC doesn't suffer if the patient defaults on the payment. In addition, the patient gets a longer period of time to pay their balance interest-free.

5. High volume centers may want to outsource.
In some situations, it makes sense for high volume surgery centers to outsource billing services because you don't want to fall behind on collections. "If you are a high volume surgery center and you constantly have dirty claims and you aren't making headway on your accounts receivable, it's usually a direct effect of your staff," says Kelly Grier, vice president of business operations for ASD Management.

Michael Pankey, RN, administrator of Ambulatory Surgery Center of Spartanburg (S.C.), runs an outpatient surgery center where physicians have about 10,000 patient visits per year. "The larger a center gets, the more beneficial outsourcing becomes because the more people your vendor can put on your account," he says.

More Articles on Surgery Centers:

10 Common Reasons Top ASC Procedures Are Unexpectedly Denied

5 Legislative & Regulatory Changes Impacting Ambulatory Surgery Centers

5 Initiatives for Higher Operating Margins at ASCs

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