FEATURE ASC Collections under Health Care Reform

Talk with your patients early to ensure success BY ROBERT KURTZ


s health care reform, greater demand for services and newer

technology drive more of the burden for health costs onto patients, ASCs lacking successful collections pro- cesses are likely to see significant neg- ative effects on their operations, says Tracey Erbert, president of health care revenue management and consultation firm in2itive Business Solutions based in Overland Park, Kansas. “Your cash collections are going

to go down, your days in accounts receivable is going to go up, your bad debt is going to go up and your over- all expenses are likely going to go up,” she says.

Despite insurance companies and

employers shifting more of the finan- cial responsibility to consumers in the form of higher deductibles and co- pays, the key to successful collections efforts essentially remain the same as they have for the past several decades, Erbert notes.

“The difference is you have to make

sure you are not only doing these pro- cesses and doing them better and more efficiently than you ever did before because the chance of capturing all of what patients owe is probably a lot less than it used to be,” she says.

Be Proactive

A challenge often facing ASCs concerning collections is the inability to tell patients the exact amount they will owe until after a procedure is completed, says Regina Robinson, administrator of Orthopedic Institute Surgery Center in Metropolis, Illinois, a new ASC scheduled to open in March. However, ASCs should work to determine as accurate of an estimate as possible and use this figure as the basis to begin collections efforts. “We will work closely with the office

physician’s to find out the

procedure(s) and what CPT code(s) will go with it,” Robinson says. “We

will use those codes when initially verifying a patient’s insurance to get an estimate of the amount due for the patient. The more codes we can use for this estimate, the closer it will be to the actual amount. This estimate is shared with the patient and used as a basis to tell the patient what they will likely owe.” It is important to determine this estimate well before the date of the procedure so you can provide patients with the figure in advance of their date of service, she says. “Once a patient’s benefits are initially verified, it is common practice to contact patients about two weeks in advance. Some are extending this to three weeks if patients are likely to need more time to come up with the money.” It is best not to wait until the last minute to inform patients what they owe, says Carol Ciluffo, vice president of revenue cycle management for Pinnacle III, an ASC management and development company based in Lakewood, Colorado. “Asking them for payment 24 hours before their procedure when they are already anxious or, even worse, informing them of payment due when they show up for their procedure is poor customer service. Work with your patients in advance so they are prepared to meet their responsibility. Eliminating surprises affords you greater success with time of service collections.” Do not let concerns about provid- ing patients with estimates that end up higher than the actual figure stand in the way of providing an estimate and collecting based on it, Erbert advises. “We have heard from some ASCs that they do not want to collect upfront because they do not want to have to issue a refund if they collect too much from the patient. But it is a lot easier to issue a refund than it is to go get the money on the back end.” Perform an initial insurance verifica- tion a few weeks prior to the procedure


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