Billing Mistakes and How to Avoid Them: Part 1

A streamlined revenue cycle management (RCM) process is critical to the success of an ambulatory surgery center (ASC). For an ASC to maintain its financial health and operate efficiently, it must develop an revenue cycle solution that handles every aspect of billing and collections, measurement and reporting, and payer contract negotiating, using industry expertise and up-to-date automation technologies.

Billing errors at any point during the revenue cycle can delay payments, impede a center’s cash flow, and have a negative impact on an ASC’s financial future.

In this two-part series, Regent RCM will explore nine common ASC billing errors – and give expert advice on how to avoid them. Here are the first four mistakes to steer clear of.

  1. Not Completing a Full Patient Record

The first step in the revenue cycle process is compiling a comprehensive patient record, including the patient’s medical history, payment receipts, and insurance benefits verification and authorization. An incomplete record can be a roadblock for coders, who often need to reference a patient’s documentation to choose the correct codes and modifiers for a procedure. Delays in coding impede reimbursement, which damages an ASC’s cash flow.

Solution: Assemble complete records for every patient, including pathology reports, implant logs, past invoices, and anything else that may influence billing. Work with a revenue cycle partner, preferably one with ASC specific experience, to identify and remedy common missing pieces in patient records.

  1. Not Verifying Eligibility

In advance of a procedure, an ASC must confirm that the claim is eligible for coverage, clarifying who is responsible for payment and what coverage is included. Costly delays often occur when claims are sent to the wrong carrier or plan, or specific authorizations for procedures or supplies aren’t approved.

Solution: When a procedure is scheduled, verify beforehand the reimbursement plan and carrier details. Pre-arrange any necessary authorizations and determine who will pay for any uncovered elements.

  1. Settling for Deficient Payer Contracts

Successfully negotiating the best payer contract rate will result in the highest reimbursement for your surgery center, but the process isn’t easy, and expertise and consistency are essential.

Solution: Andrea Woodell, VP of Managed Care, has a 20-year history of negotiating payer contracts and securing gains. She has a variety of best practices and recommendations but always warns centers to begin early, starting at least four months prior to the anniversary of your contract. Click here and here to learn more.

  1. Giving Unnecessary Discounts

While there are exceptions, ASCs should not adopt the habit of providing discounts or waiving fees for patients. Routine reductions are likely motivated by good intentions, but they can have a harmful effect on a center’s finances. They also may break terms of some insurance contracts.

Solution: Be open and transparent with patients about financial responsibility when a procedure is scheduled. Inform patients of what will be covered by insurance and what they will be expected to pay, offering payment plans or other alternatives if they are available.

Need expert assistance in improving your revenue cycle management? Contact Regent RCM.