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COVER STORY


Give Your Revenue Cycle a Tune-Up


Boost collections with transparency and up-front payments BY SAHELY MUKERJI


D


epending on specialty, geogra- phy, payer mix and technology, the critical components of an ASC revenue cycle can change, says Lind- say Miller, executive vice president of operations at National Medical Bill- ing Services in St. Louis, Missouri. “The ASC revenue cycle is nuanced because of its complexity in all of these areas. Each ASC faces its own set of challenges,” she says. Contract negotiation is one of the


most important aspects in the reve- nue cycle. “Having someone within your ASC—one who understands the payers and your specialties—respon- sible for negotiations will make sure that your ASC gets paid appropri- ately,” Miller says. “This person would have to develop relationships with the managed care representa- tives on the payer side and watch the


market to make sure that your ASC is getting paid what it should.” A majority of the audits that National Medical performs indicate that most ASCs don’t know if they are get- ting paid correctly because they are not able to locate their managed care contracts, she says. “Does your bill- ing team have access to all pertinent contracts? They should as they are usually the ones who are tasked with making sure your ASC has been paid correctly,” she adds.


Bill Hazen, RN, administrator of


the Surgery Center at Pelham in Greer, South Carolina, says that good data and/or analytics to document how much an ASC is paying for a proce- dure help to get a good contract. “You have to understand your costing and be able to show it to your payer, vendor, buyer, supplier and your patients,” he


14 ASC FOCUS MAY 2018 | www.ascfocus.org


says. “For instance, we wanted insur- ance companies to pay for our implants but they refused. So, we attached a bill for an actual implant that showed dol- lar per dollar how much it cost us. That made insurance companies change their mind. “That was the transparent way to


do business,” he adds, “and we do the same with our patients because that is doing right by them.” With patients, Hazen recommends being up-front from day one. “It has become a cash world and almost 40 percent of my business is cash now,” he says. “So, even before we talk to a patient, we call the patient’s insurer and figure out how much the patient would have to pay. Patients are more educated now and want to know what they would pay and why. We take the time to break it down for them.” Many of the patients now have $10K or $15K as deductible/coinsur- ance, he says. “If we don’t start the pro-


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