FEATURE
Ewing says ASCs should be paying closer attention to patient collection rates. “As high-deductible health plans increase—and they are increasing, larger patient payments are becoming more prevalent and important to an ASC’s performance.”
She adds that benchmarking payer mix can provide insight into changes in collections. “Even if your case volume stays consistent, if you are performing more procedures on Medicare patients rather than commercial patients, your collections may decrease since Medi- care typically reimburses less.” Appleby says her ASC pays close attention to physician dictation and doc- umentation. “We benchmark our physi- cians’ performances in these areas. We want to make sure dictation and docu- mentation are done on time and contain the correct information so we can code and bill correctly.” Also important to Appleby is her
ASC’s denial rate. “We want that to always be under 5 percent. We are con- stantly looking at the reasons for any denials and then working to prevent them from occurring again.” Ciluffo says benchmarking
revealed that some of Pinnacle III’s ASCs experienced an increase in denials due to the switch to the 10th revision of the International Statis- tical Classification of Diseases and Related Health Problems (ICD-10). “Some of our physicians were not coding to the higher level of specific- ity required by ICD-10. We provided information outlining how physicians could address these specificity issues to our ASC administrators to share at their board meetings.”
She adds that benchmarking an
ASC’s denial rate is critical because payers deny claims for many reasons. “More ASC resources are required to ensure payers’ contractual terms are adhered to prior to seeing patients. This is particularly important with pay- ers who require pre-certifications and
When you can identify problems—and everyone has problems— you can work to determine the causes and fix them.”
—Crystal Ewing, ZirMed
pre-authorizations. If you fail to secure prior approvals up front and a claim is denied, the ASC could lose money, both in potential revenue and case costs. Consider creating a cheat sheet of your top procedures that identifies different payer requirements and provide it to your billing staff for easy reference.” Ewing says a complimentary bench-
mark to track is clean claim rate, an area that she says is often a challenge for ASCs. “This is basically how often you send a claim that does not deny. You really want to get that into the high 90 percent range. The higher the percentage, the lower your number of denied claims.” Benchmarking net revenue per case
provides valuable insight for Appleby. “That can tell us if we need to revisit contracts with our payers or, perhaps, if our write-offs are increasing.” In addition to monitoring write-
offs, she says her ASC trends bad debt. “We always want to know if it is rising. We examine what financial assistance we provide, number of patient bank- ruptcies and what we are sending off to collections.”
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Benchmarking is only as valuable as what an ASC does with the informa-
tion, Appleby says. “When our bench- marking reveals something of con- cern, we immediately analyze the process. We pull in all of the people involved in the process, and then we form a process improvement group to drill down, identify where the prob- lem resides and create a reasonable plan of correction.” Ewing says there are three fac- tors that go into making revenue cycle improvements: people, processes and technology. “Ask yourself, ‘Do I have the right people performing our jobs? Do I have the right processes in place for our people to perform their jobs effectively? And do I have the right tools to do those jobs?’ Use benchmarking to find where you struggle in these areas and then tar- get them for improvement.” Do not avoid benchmarking out of fear of discovering your ASC is not performing as well as you thought, Ciluffo says. “Benchmarking needs to be embraced. Be friends with your numbers, even when they aren’t exactly what you want to see. Some- times the ‘failures’ you discover lead you to successes; they allow you to address problems and tighten pro- cesses. If you do not know your per- formance is lacking, that, in my opin- ion, is much worse.”
ASC FOCUS FEBRUARY 2017 13
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