COVER STORY Checklist for Success

Lindsay Miller, executive vice presi- dent of operations at National Medical Billing Services in St. Louis, Missouri, suggests that ASC administrators ask themselves the following questions in the various areas of operation to man- age their revenue cycle effectively.

Coding: Medical billing functions are done differently at different centers. Does your ASC have someone who un- derstands the specifics of your medical billing functions? For instance, if you do spine procedures, do you have the right expertise to understand the ser- vices and all that goes with them? Are your coders certified? What is their expertise level for coding in ASCs as it relates to your specialty or specialties? Are you performing routine audits to make sure your coders are on top of regulatory and payer changes?

Charge posting: Charge posting is a manual data entry function. Some systems automate it, but 99 percent of the time implants need manual posting. This is due to different costs associated with implants and differ- ent contractual requirements, such as cost-plus invoice, thresholds, different revenue codes and trailer billing. It is always a good idea to perform routine audits on your implant billing.

Claims submission: Do you know your top claim rejection reasons? How quickly is your team working on the rejections? They should be worked the same day. If not, understand why and work on it. Do you know your ASC’s clean claim rate? We like to see our ASCs hitting at least a 95 percent clean claim rate. This is a good indica- tion that your claims are going out with the correct information in the correct fields. Clearing houses have scrub- bers to make sure the claims are clean when they leave your center. Are you utilizing your edits and maintaining

responsible for tracking denials with journal codes or queuing up denials for your accounts receivable team? Are your payment posters posting per line item? This should be audited routinely as well. Audit the system that tracks the denials. Payment posters should reconcile deposits daily and to the bank. Balancing is key. It helps if they have access to the bank account, with read-only permissions.

them? Make sure that your claims are leaving your center in a timely manner. The acceptable time between the ser- vice and the claim is within 72 hours. If it is more than 72 hours, drill down on why. Is it the dictation service or maybe a template in the EHR? Or is it something you are waiting on from the vendor to bill? For example, pathology reports and implant invoices. What percentage of your claims are going out electronically versus paper? If your claims go out on paper, are you send- ing the correct information? Do your claims include op reports and every- thing they need for the payer?

Payment posting: Make sure that your claims are paid according to your con- tract. It is a good idea to look at the payments routinely and evaluate them for accuracy. Use your practice man- agement system to its fullest capabil- ity. Check frequently for product up- dates and automation opportunities. Audit the automated posting process- es to make sure they are working ap- propriately. Typically, payment posters are the first people to see correspon- dence from the payers, so, it is impor- tant to have good communication with the posters. Are your payment posters

Accounts receivable (AR): It is im- portant to have a good AR strategy in place. The two critical components of AR are bringing cash in and identifying issues that are preventing cash from coming in. Are the stakeholders in your ASC familiar with the current payer issues? Is there a good way to track them? Are your highest paying claims being worked properly? What are your days in AR? How much of your aging is sitting over 90 days?

Compliance: Does your facility have a standard operating procedure compli- ance manual for your billing process- es? Some of these items might include Health Insurance Portability and Ac- countability Act (HIPAA) compliance, payment card industry (PCI) compli- ance, coding compliance, Office of In- spector General (OIG) compliance and patient billing compliance.

Analytics: How frequently does your ASC get its revenue cycle data? What format is the data in? Is it easily un- derstood? Does it answer all questions and concerns relating to cash flow, vol- ume, specialty mix, payer mix, denial trends and physician performance? ASCs need to understand their daily cash collections to help them trend the rest of the financials for the month. Check if your cash-per-case is in line with the rest of the industry. At a mini- mum, you should be receiving an end- of-month financial roll up that includes all of the items discussed above.

ASC FOCUS MAY 2018 | 15

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