cess up-front it does not matter what we do with billing in the back end. We truly do case costing live to the penny. We have to get part of the co-insurance up-front because if not, we might not get reimbursed for the implant.” Often, patients are not informed of

how much their portion of the surgery will be before their surgery takes place, Miller says. “So, they get upset when they get the bill after surgery. Patients often times owe more than 20 percent of the cost of the procedure. With the increase in patient responsibility, the patients are now considered a payer. Therefore, the front-end due diligence of the surgery center has become very important. Explain the patient’s por- tion of the surgery to the patient before they have their surgery.” For the Orthopaedic Surgery Cen- ter of Clearwater, Florida, front-end work comprises the most important part of the revenue cycle. “It is good cus- tomer service to let the patients know their out-of-pocket before they get their surgery,” says Chris Markford, CASC, administrator of the ASC. “As soon as we have the surgery schedule from the physician’s office, we do up-front research to find out the patient’s out-of- pocket. Patients are typically worried about the cost, and we don’t want to surprise them with an unexpected bill.” The patients sign an Assignment of Benefits (AOB) form that allows the surgery center to talk to their insurer, Markford says. “Our scheduler han- dles that part and she also calls the patient to explain the costs. Every case is different, and we have to treat them differently. One might need a payment plan, another might need third-party medical financing, but it always helps to keep the patient informed. This also helps the revenue cycle because we work with the patients to collect the copay up-front.” It is always easier to collect before

the surgery than after, he says. “There are people who get their surgery and refuse to pay. The physicians’ pol-

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.”

— Bill Hazen, RN Surgery Center at Pelham

icy is to get paid up-front. So, after paying the physician, a patient might think he has already paid the doctor and refuse to pay the ASC. Then you might have to go to plan B and send them to collections.”

Sending a patient to collections is a hard decision for an ASC to make for a variety of reasons, Miller says. So, helping a patient understand what they owe up-front and having them pay at least a portion before surgery is the ideal way to go.

If a patient cannot pay on the day

of surgery, Miller asks, what is your ASC’s policy on patient billing fol- low ups? “Once a month? Three state- ments—per month—followed by phone calls? For how long? Do you then send them to collections?” Each state has its own regulations regard-

16 ASC FOCUS MAY 2018 |

ing patient billing practices, she says. “Understand your state’s regulatory patient billing practices. How many statements are you allowed to send to your patient? How many past due statements are you allowed to send?” If a patient feels harassed with your patient follow-up practices, it could have a negative effect on your facil- ity’s reputation. “In some extreme instances, we have seen patients go to local TV channels, radio stations, hiring attorneys and filling complaints with the Better Business Bureau,” she says. “This is an area where ASCs should pay a lot of attention.” Hazen recounts experiences similar to Markford’s. “Because of the Afford- able Care Act, some patients feel enti- tled and say ‘you need to treat us with- out payments,’” he says. “However, we are a for-profit surgery center, and we do elective surgery.” If a patient is unable to pay what the ASC requires up-front, it sends the patient to an outside agency for financing options. “We also have a charity program that we refer patients to. In addition, if a patient does not have insurance, we do a pretty substantial reduction for cash payment. We give the patient a 20 per- cent discount and another 20 percent when they pay 100 percent up-front on the day of service.” To make it easier for patients to

make payments, “maybe have a patient portal that the patient can use to pay, a tablet, a kiosk or the ability to pay on their phone,” Miller recommends. “Patients like that instead of getting a bill in the mail. Give them different means and methods to pay their bill. Explore the options and pick the right one for your ASC and patient base.” Patient

satisfaction is a primary

goal of ASCs. “I speak to every patient who comes for surgery every day,” Hazen says. “That personal touch helps if and when an issue comes up and makes sure that the patient gives us a good reference.”

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