8 tips for ASCs to work more effectively with their RCM vendor partner

In an ideal situation, outsourcing your ASC's revenue cycle management (RCM) is like having an efficient and convenient extension to your business office.

The ASC performs front-office tasks while the RCM vendor carries out the back-office responsibilities, working together to achieve the ASC's financial goals.

Here are eight tips to help your ASC collaborate more effectively with your RCM partner.

1. Understand responsibilities of RCM vendor. RCM services should be stipulated in your vendor contract. They may vary between vendors. At a minimum, RCM vendors should provide all the following services:
a) coding by a certified coder;
b) charge posting;
c) claim submission;
d) payment posting;
e) collections;
f) follow up on denials;
g) necessary appeals;
h) patient statements;
i) production reports;
j) aging reports; and
k) other specified reports or duties.

2. Understand responsibilities of your ASC. To help ensure that your RCM vendor can provide the best possible revenue results, your ASC must fulfill the responsibilities outlined in your billing contract. These include HIPAA-compliant, accurate and timely provision of:
a) current fee schedules;
b) up-to-date roster of all center providers with current provider numbers;
c) personnel contact information;
d) third-party payer contracts entered in computer system, with updates as they occur;
e) patient demographics entered in computer system;
f) scan or copy of insurance cards;
g) date of service;
h) dictated and transcribed provider reports;
i) list of EFT payments received by your bank;
j) EOBs and/or any insurance payments received by mail
k) patient payments received; and
l) access to your electronic data 24 hours a day, seven days a week, including holidays.

3. Facility policies. Your ASC should share relevant policies with the RCM vendor. It is especially important that the RCM vendor understands your financial polices concerning:
a) collection prior to services (e.g., deductibles, copayments, co-insurance);
b) Medicare;
c) Medicaid;
d) commercial insurance;
e) workers' compensation;
f) liability (auto, litigation, lien);
g) self-pay patients;
h) promissory notes;
i) out-of-network coverage;
j) secondary insurance;
k) courtesy discounts;
l) charitable consideration;
m) non-covered procedures; and
n) bad debt adjustment procedures.

4. Contact person. Your ASC should designate a contact person to assist the RCM vendor in obtaining necessary billing data and answering any questions. The RCM vendor should appoint a member of its team as a point person for interaction with the ASC's designee.

5. Response time. Your ASC and RCM vendor should provide timely responses to requests for information. Each day, your ASC should send a copy of all checks or payments received on site to the RCM vendor. It is also important that your ASC promptly notify its RCM vendor of any refunds made to patients or third-party payers relevant to services provided at the ASC.

6. Goals. Both your ASC and RCM vendor must understand what is expected of them. Work together to establish realistic performance goals and spell these out in the RCM agreement. They should include stipulated time constraints for the following:
a) time between receipt of appropriate provider report and coding by RCM vendor;
b) time between completion of coding and submission of claims;
c) time between receipt of payment and posting to appropriate patient account; and
d) time between claim submission and collection follow-up.

Goals should also be established for:
a) frequency of collection efforts;
b) when to implement appeals; and
c) when and how frequently to send patient statements.

7. Oversight. Your ASC's business office coordinator or designee should be responsible for overseeing the performance of the RCM vendor and reporting results to your administrator and governing body.

8. Meetings. Regular phone conferences should be held between your ASC and RCM vendor management personnel to discuss issues encountered and deliver interim financial reports.

As outlined above, understanding the needs of both your ASC and its RCM vendor partner and communicating them clearly is vital to a successful partnership. With ongoing interaction and cooperation, this partnership can seamlessly achieve optimal results in providing your ASC with a steady and maximized revenue stream.

Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing, an ASC revenue cycle management company. Serbin Medical Billing's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Ms. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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