With thin margins and many costly, implant-heavy procedures, ASCs need effective accounts receivable (AR) management to protect cash flow, reduce revenue leakage and sustain long-term financial sustainability. One missed prior authorization or overlooked benefit detail can result in thousands of dollars in losses for an ASC.
In a recent Becker’s Healthcare webinar sponsored by nimble solutions, two revenue cycle experts shared how ASCs can increase payer collections and strengthen accounts receivable:
- Tonya Bailey, vice president, RCM solutions, nimble solutions
- Dylan DeScheda, vice president, accounts receivable, nimble solutions
Four key takeaways were:
- ASCs must master the payer contract landscape. When it comes toAR management, ASCs must understand payer trends, contract reviews, denial prevention and underpayment detection. AR teams with deep payer contract expertise are better positioned to navigate complex payer rules and changing requirements. Contract mastery extends beyond negotiation to daily operations and oversight. Ms. DeScheda explained that if ASCs apply contract mastery to their day-to-day AR operations, they will likely see improvements in revenue.
- An efficient revenue cycle starts with the front end. Too often, ASCs view the front end only as the desk where patients check in. In reality, the front end of RCM starts as soon as a patient is scheduled. Key processes include verifying eligibility, documenting benefits and obtaining pre-authorizations. Before procedures, ASCs also must inform patients about their expected balance and why they may receive more than one bill. “The best AR strategy is preventing problems,” Ms. Bailey said. “To do that, your front-end services must be extremely clean and tight.”
- Compliance with payer policies and coding accuracy are essential. When claims and coding fail to align with payer policies, ASCs invite denials and inevitably leave money on the table. Medical necessity compliance protects revenue by ensuring that procedures meet payer-defined criteria and documentation standards. Accurate coding and documentation safeguard reimbursement by reflecting the full scope of care that was delivered. Disciplined coding and compliance are the foundation of payer trust and long-term financial stability for ASCs.
- Strategic AR management and compliance maximize cash per case and patient-focused care. When an ASC partners with nimble, the ASC ends up taking a more strategic approach to AR. A result is that every case is more likely to generate its full financial and clinical value.
Proprietary workflows developed by nimble use collectability algorithms to identify priority accounts. This maximizes the return on follow-up efforts. AI-enabled denials management reduces resolution time, while automated claims statusing minimizes delays and improves cash collection. nimble’s payer contract calculators also leverage automated contract checks to identify underpayments and recover revenue.
“Don’t leave cash on the table,” Ms. DeScheda said. “Every AR improvement translates to stronger margins and more resources for patient care.”
