DOING BUSINESS


The volume by payer report, or payer mix, might identify an increased number of cases from a lower-pay- ing payer and decreased caseload from higher-reimbursing payers. If a substantial decrease is found in the amount of cases from a specific payer, contact the payer representative to determine the reason(s). Payer mix variables might cause the following: 1. decreased total A/R due to cases with lower reimbursement/higher write-offs—e.g., Medicaid—re- placing higher reimbursing pri- vate payer cases;


2. increased aged A/R due to an in- crease in slow-paying cases, e.g., workers’ compensation, liability, out-of-network; and


3. decreased A/R due to a de- crease in caseload from a high-


reimbursement payer. Follow up with the appropriate provider or payer to ascertain reason(s) for a change in case mix. The volume by specialty


report


reveals how changes in caseload by specialty might cause A/R fluctuations. If there is no appreciable decrease in total cases, review the case mix by specialty report. If a significant drop is detected in the number of cases per- formed by a high-volume orthopedic surgeon, and your scheduler is filling open schedule blocks with gastroenter- ology cases, this will cause a dramatic decrease in your total A/R and cash flow. Contact the orthopedic surgeon to identify the reason for the decreased caseload. If you determine that you will permanently lose the cases, mar-


ket to other high-volume, high-reim- bursement providers.


Prioritizing EOM Reports EOM reports provide valuable informa- tion that can help identify and improve your center’s RCM efforts. Research all applicable reports available in your soft- ware to identify those reports that pro- vide insight into your specific revenue stream challenges. Once identified, review these reports on an ongoing basis to determine if auditing and staff edu- cation efforts result in positive changes in your ASC’s financial health.


Caryl Serbin, RN, is president and founder of Serbin Medical Billing in Fort Myers, Florida. Write her at caryl@ serbinmedicalbilling.com.


28 ASC FOCUS JUNE/JULY 2020 | ascfocus.org


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