AS I SEE IT


Satisfaction Guaranteed Patients embrace up front conversations about costs of care BY CORRIE MASSEY


Insurance payers seeking to tighten requirements for ASC reimbursements are already modeling claims payments on hos-


pital outpatient department (HOPD) markers such as outcomes. In addition, many health care analysts anticipate that patient satisfaction scores will be the next indicator that influences ASC reimbursement. In an informal study of patient sat-


isfaction levels at our facility, we found that patients were highly satisfied with the medical care they received but we had an opportunity to improve our business office communications with patients. We also realized that many patients were shopping around at other facilities before surgery and asking pointed questions about their antici- pated surgical charges. In an effort to improve our patient satisfaction scores and meet the demands of increasingly cost-conscious patients, we decided to embark on a business office communi- cation strategy that bridged those gaps.


Insurance Verification Appropriate insurance verification is the first step in determining a patient’s estimated costs. Business office staff should become experts not only in the facility’s contracts and carve outs, but also in staying on top of claims to deter- mine denial and low payment trends. Identifying a selective group of staff that is responsible for collecting this information and accountable for report- ing it to facility leadership is crucial. Our ASC’s pre-operative verification process requires staff to identify all of the potential procedure, diagnosis and implant codes expected to be involved in each patient’s surgery. This alerts our business office staff if any of these


10 ASC FOCUS MARCH 2015


elements are not covered or require special authorization for payment. One example is the urological use of


Botox for urinary incontinence.


(onabotulinumtoxinA) Some


plans have begun paying for both the treatment and the Botox with appropriate pre-authorization, while others continue to deny payment for the medication as “experimental” even though they approve the cystoscopy procedure itself. Others deny both the procedure and the injection altogether. Careful vetting of these codes and contracts allows our business office staff to present all of the facts when speaking with each patient about their anticipated expenses.


Create a Financial Policy When establishing a comprehen- sive financial policy, including a sec- tion that outlines the steps to take and the financial guidelines of accounts receivable is vital.


Inspectors from


the Centers for Medicare & Med- icaid Services (CMS), the Accred- itation Association for Ambula- tory Health Care (AAAHC), and the American Association for


Accredi-


tation of Ambulatory Surgery Facili- ties (AAAASF) are now interested in the financial policies that their accred- ited facilities follow. Inconsistencies noted on a survey could lead to defi- ciencies that require a plan of correc- tion. Therefore, ensure that if your pol- icy states that your facility requests payment at the time of service from all patients, you also prescribe steps for documenting your request for payment and any reasons why a patient might not have paid. Your


facility’s financial policy should include a process that patients experiencing


financial hardship can


follow to request a payment reduction and outline the review and approval process for such requests. Many cen- ters are being investigated by insur-


The advice and opinions expressed in this article are those of the author’s and do not represent official Ambulatory Surgery Center Association policy or opinion.


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