By Michael Orseno, Revenue Cycle Director, for Becker’s ASC Review
Michael Orseno, revenue cycle director for Regent Surgical Health, discusses five steps ambulatory surgery centers should take to improve their billing and collections efforts in the new year.
1. Make sure all of your payor contracts are loaded into your billing and collection software. If your billing and collections software allows it, make sure all of your contracts are uploaded, Mr. Orseno says. This will feed into other areas such as electronic remittance advice (ERA) — an electronic version of a payment explanation — and contractual variance reports. Some payors change their rates at the beginning of the year, so ensure all of your existing contracts are up to date.
2. Review your managed care contracts to make sure you’re being paid properly. “If you have your contracts loaded into the system, it makes management’s job exponentially easier because you will be able to run reports to determine how much you were paid versus how much you were supposed to be paid for different procedure codes,” Mr. Orseno says. “Then you can identify where you’re being underpaid or if you’re not charging enough for a particular procedure.”
3. Enable ERA and electronic funds transfer (EFT) with all payors. Once you have ERA coming from your payors, your ASC can now start auto-posting. “Auto-posting will cut down tremendously on your staff costs,” says Mr. Orseno. “Once you have the contracts loaded in the software, your poster will see how much you were supposed to be paid, how much [the payor] paid and whether or not they should post it or not. This is all done electronically and at half the time it used to take manually”
Enabling EFT will get funds to you facility faster and also help prevent the likelihood of fraud or lost checks.
“Both ERA and EFT will help decrease your A/R days,” Mr. Orseno says.
4. Use your clearinghouse to send attachments to payors electronically. Mr. Orseno says many delays he has seen in the A/R process are attributable to the requirement set by most payors of requiring documentation to support submitted claims. This documentation includes operative reports and implant invoices.
“Now our clearinghouse allows us to scan [these documents] and send them electronically,” he says. “Some payors will accept the attachments electronically, some won’t, but our clearinghouse will handle that. For those that [accept attachments electronically], we now have date-stamped material, so if the payor comes back and says we haven’t sent this, we have documentation with both the date and time it was sent.”
If your clearinghouse doesn’t offer this as an option, Mr. Orseno advises you to push for it because “this is the way of the future,” he says.
5. Arrange for payment on all unmet deductibles and coinsurance upfront. Mr. Orseno says this step is especially important this time of year as most patients have unmet deductibles and higher co-insurance and/or co-pays. Arranging for payment on all unmet deductibles and coinsurance upfront will help decrease collections costs and days in A/R, he says.
“And it’s important here that we’re saying arrange for payment of unmet deductibles and coinsurance,” Mr. Orseno says. “We want our centers to arrange for payment, not necessarily collect on them. Collecting on them leads to myriad issues, including increased staff costs and legal issues. On the one hand, it’s a positive that the center is bringing money in the door, but some contracts, such as Medicare and others, won’t allow that.”
It is very challenging — often close to impossible — to determine how much of the deductible will hit the ASC, he says. If full payment is collected on the front end and the physician’s office gets hit with the deductible, the ASC must spend staff time processing refunds.
Mr. Orseno recommends ASCs use a credit card authorization form, take a patient’s credit card information and authorize the charge of a certain amount. When the claim is adjudicated, call the patient and inform him or her of how much you’re going to charge the credit card at that time.
“Physician offices are collecting money now, so a lot of times the ASC will be left ‘holding the bag’ when patients say they already paid the physician and are not going to pay [the ASC],” Mr. Orseno says. “So if you just arrange for payment, you’re not really collecting a payment until the claim is adjudicated.”