The financial health of your ambulatory surgery center (ASC) depends on accurate, efficient revenue cycle management – which is difficult to maintain in an increasingly complex insurance environment. Submitting clean claims to payers is an important step in decreasing delays and denials, but it is only one part of the equation. To ensure your ASC is paid properly and promptly, take a proactive approach to streamlining your revenue cycle.
Here are three ways to improve your ASC’s revenue cycle management and work toward your profitability goals.
Evaluate & Update Payer Contracts
Review all of your current payer contracts and fee schedules. Are payers sending appropriate reimbursements as agreed upon in your contracts? Have any payers updated or waived certain costs or processes because of COVID-19? When was the last time you renegotiated contracts with your most common payers? If you haven’t revised a contract in some time, you may not be receiving the best rates.
Track Key Payer Metrics
To gain a better overall view of your ASC’s financial picture, collect information on claims and reimbursements, and grade major insurance payers on key metrics. Start by asking these questions about each payer:
- What do they pay for a procedure?
- How fast do they pay?
- What percentage of claims do they deny?
Use this data to understand how common denials are and how much time your staff is spending to collect from each payer. Can you pinpoint any trends associated with delays or denials? Are you including all of the information needed for a claim? Are you submitting clean claims and still having to appeal incorrect denials? If you notice that your team frequently battles with a payer over correctly billed claims, resulting in hours of lost staff time, you can use this information to push for changes or contract renegotiations.
Follow Up Quickly
Establish a schedule of follow-up practices for outstanding claims and erroneous denials, and remember not to accept the payer’s first payment. Calculate your ASC’s average days in A/R, and set a goal for following up on claims to reduce that number. If your ASC receives a denial where the payer is at fault, set a timeframe – such as 24 hours – in which your staff must resubmit the claim or file an appeal.
Effective revenue cycle management requires diligence and consistency. Partnering with ASC revenue cycle experts can transform your center’s financial health. Get in touch with Regent RCM to optimize reimbursement and solve problems in your revenue cycle.