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reports that might reveal the exact cause(s). Run the physician utiliza- tion report to identify a decrease in caseload by specific provider(s) and determine if it is an ongoing trend. Intermittent or single-month case- load decrease might mean the pro- vider is on vacation. If the caseload decline trends over several succeed- ing months, the provider might be performing cases elsewhere. Contact the provider to ascertain the reason for this decrease. The following examples demon-


strate how RCM functions can impact the results of A/R as a measurement of your ASC’s performance: ■


■


A change in the number of CPT codes assigned to each case might indicate a need to investigate whether the center’s specialty mix has changed (volume by specialty report). If no


in number of codes per case indi- cate the need for a coding audit and coder education.


■


significant change is detected, inves- tigate your coding process.


A decrease in CPTs per case might be the result of erroneous bundling of procedures by an inexperienced coder. Conversely, inappropriate unbundling of procedure codes can increase CPTs per case. Signifi- cant and continuing fluctuations


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A decrease in gross or net col- lections causes an increased A/R total. This might indicate payer trends in claim processing or poor collector productivity. If investiga- tion of payer trends—payer aging report—fails to identify backlogs in claim processing, perform a col- lection audit, concentrating on out- standing claims over 90 days to determine timeliness of collection efforts. Audit results might signify a need for an improved tickler sys- tem, provision of appropriate aged A/R reports to collectors and/or additional collector education.


An obvious increase in monthly patient refund amount might reveal an upfront collections issue. Audit the timeliness and adequacy of insurance verification, patient financial


counseling and/or up-


front collections processes. Share the results with staff.


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An increase in payer refunds might indicate an issue with posting third- party payer reimbursements. Deter- mining whether to audit the charge posting or payment posting process depends on whether write-offs are completed at the time of billing or reimbursement. The payment post- ing audit should include examina- tion of the number, dollar amount and reason(s) for write-offs. The aging by payer report measures total A/R by sorting the total balance due into separate buckets by payer and age of the account(s). To determine patient balance amount, separate patient and third-party payer A/R. If the majority of over 90 days is patient balances, audit upfront collection policies and procedures, including those for pay- ment plans, patient statements and bad debt. Share the findings with staff to determine any need for changes in policies and procedures and/or additional education.


26 ASC FOCUS JUNE/JULY 2020 | ascfocus.org


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