1. Check eligibility. Some ASCs are not checking patient eligibility or are managing it ineffectively, Mr. Weinstein says. For example, some centers check too far in advance, such as three weeks before surgery, so that benefit specifics could easily change. Verify eligibility a day or so before the visit, either directly or in an automated extract from the practice management system. “Doing it a day or so in advance gives billing staff time to address any errors,” he says. Errors could be due to misspelling the patient’s name, forgetting to update eligibility information or the patient switching jobs.
2. Simplify the payment system. Managing each type of submitted claim often involves a different workflow process. Mr. Weinstein says companies like ZirMed offer systems that help ASC staff process information for all payors through one portal, utilizing one workflow. “This streamlines the claims management process by making it easier to correct and update claims information as well as track reimbursements,” he says.
3. Review past problems. Being able to identify and compile reports on past problems with claims submissions can help the ASC learn from its mistakes, Mr. Weinstein says. Choose a computer system that allows ASC staff to perform a sophisticated analysis of past billing to determine where problems or opportunities for improvement may exist. “A robust system and process of business intelligence applied to the revenue cycle will help ASCs cut down on claims denials and save money,” Mr. Weinstein says.
4. Manage compliance. A growing number of regulations is making compliance management more challenging, Mr. Weinstein says. For example, the switch to HIPAA 5010 on Jan. 1, 2012 will require submission of all ZIP codes in nine-digit format. “Small issues like this can hold up reimbursement,” he says. Ensure that revenue cycle management vendors are compliant with HIPAA 5010 before Dec. 2011 and that the center’s practice management system will be compliant as well. “Most PM system vendors will offer an upgrade if they haven’t already,” Mr. Weinstein says. Another option is to work with an intermediary like ZirMed, which takes care of these issues. “A solid revenue cycle management vendor removes much of the burden on ASCs of having to manage all of this directly and on their own,” he says.
5. Manage patient payments. Due to a rise of high-deductible insurance plans, the portion of ASC revenues paid by patients has risen from 5 percent to as high as 25 percent, in some cases, during the past five years, Mr. Weinstein says. “Out-of-pocket payments have gone from something the ASC didn’t have to worry much about to a critical part of their business,” he says. Below are some specific pointers for managing patient payments.
6. Get patients’ early commitment to pay. Someone from the billing office should talk with the patient before the procedure and communicate expectations upfront. Ask patients to sign a preauthorization statement saying they will pay their portion of the bill.
Staff could get payment information from the insurer and estimate how much the operation will cost, or they could rely on past billing experience to come up with an estimate. For example, on a $10,000 knee operation, the patient’s out-of-pocket estimate might be $2,500. Prior to the procedure, the staff would inform the patient that on his $10,000 knee replacement procedure, his responsibility might be as high as $2,500. The patient would then provide his credit card information to allow as much as $2,500 to be deducted from his credit card.
In this process, sometimes called “automatic collection,” the payment would take place after the ASC has reconciled the remittance information from the payor, which in a streamlined billing operation happens within two weeks after the procedure. Without automatic collection, the ASC would have to use the historical method of reconciling, creating and sending a bill, and then waiting 45-90 days to be paid.
7. Allow patients to pay online. Whether the statement is sent to the patient by email or on paper, it should include an option to pay online with a credit card. “Patients should be offered as many payment options as possible,” Mr. Weinstein says. “This increases the likelihood that they will pay more quickly.” Many revenue cycle management vendors provide an online payment capability, but look for a partner that will consolidate patient payment information and payor reimbursement information into one platform that allow easy reposting into the ASC’s practice management system.
8. Use lockbox service for mailed payments. An ASC with more than 4-5 physicians usually has enough volume to justify hiring an outside agency to process mailed payments. Payments are sent to the agency, sometimes called a “lockbox service,” which opens the mail, scans checks, creates electronic transactions and deposits the checks in the ASC’s bank. The lockbox service keeps a long-term record of transactions, including images of paid checks. “The best providers of this service integrate mailed payments from with reimbursements from payors and other patient payments, so that the ASC has just one workflow to manage all payments,” Mr. Weinstein says.
9. Allow patients to go on a payment plan. In today’s bad economy, some patients may not be able to pay the full amount of their bill immediately. “ASCs should have the capability to generate a patient payment plan with regularly timed payments,” Mr. Weinstein says. Typically, the full amount should be paid back within a 12 months. When patients opt for a payment plan, some ASCs perform elaborate credit checks. But Mr. Weinstein says the value of such an approach should be balanced against the time and expense and how it might affect the patient relationship. When collecting financial information, ASCs must be compliant with the Payment Card Industry Data Security Standard, so that patient payment information does not get into the wrong hands.
Learn more about ZirMed.
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