Caryl Serbin, president and founder of Surgery Consultants of America and Serbin Surgery Center Billing, and Becky Ziegler-Otis, administrator at the Ambulatory Surgical Center at Stevens Point (Wis.)., discussed how several changes to the Stevens Point’s billing and coding processes increased reimbursement and reduced days in A/R for the center.
During the event, Ms. Serbin mentioned the following signs that an ASC may be in trouble, all of which were experienced by Stevens Point:
- Decreased revenue
- Increased days in A/R
- Inefficient billing and coding processes
- Non-complaint billing and coding processes
Recognizing that it was in trouble, Stevens Point worked with Serbin Surgery Center Billing to perform a full evaluation of Steven Point’s coding and billing processes. The evaluation included the following recommendations:
- Purchase ASC-specific software
- Hire additional coding and billing staff or outsource
- Move insurance verification to back office (Stevens Point was using a receptionist to verify insurance)
- Provide CMS list of ASC covered services and matrix of insurance contracts to scheduler and insurance verifier
- Collect out-of-pocket fees upfront
- Notify patient of financial responsibility before day of surgery
- Undergo coding audit to identify inaccurate coding
- Follow up regularly on submitted claims
- Notify payor of out-of-network patients at time of verification
- Review fee schedule
Stevens Point was able to implement all of the recommendations and eventually decided to outsource its coding and billing processes. As a result of implementing the changes, Stevens Point experienced the following improvements:
- Days in A/R decreased 25 percent from 79 to 44 days
- A/R over 120 days decreased from 22 percent to 8 percent
- Average Collections increased from $160,000 to $250,000 per month
- Average Gross Charges increased from $353,860 to $584,055 per month
ASCs with similarly inefficient coding and billing processes can likely improve their own reimbursement and collection activities by making many of the same changes made by Stevens Point.
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