DOING BUSINESS
Improve Your Revenue Cycle Performance Graduate from ‘good enough’ to ‘great’ BY ANGELA MATTIODA
To get paid, ASCs must perform a series of func- tions, including insurance verification, authorization, chart prep, dictation and
transcription, coding, claim submission and payment posting. When centers complete these in a reasonably efficient manner, the revenue cycle should gen- erate enough income to cover expenses, give employees occasional raises, make periodic new investments and deliver consistent distributions. All in all, these sound like acceptable results. ASCs, however, do not need to set-
tle for a revenue cycle performance that is just “good enough” when great- ness might be not that far out of reach.
Reconcile Your Schedule A priority for any ASC must be rec- onciliation of the schedule to ensure claims are submitted.
While this
might sound elementary, centers often leave significant dollars on the table because they fail to consistently com- plete this step. Claims can be submitted improp- erly for many reasons. Simple reasons could be that a team member forgets to click the “submit” button within the clearinghouse or the system rejects the attempted
claim submission. Other
causes of claim rejections can include mismatched payer, claims out of bal- ance or a typographical error
in a
patient's identification or date of birth that prevents the system from finding the patient's file.
As important as it is to try to reduce the likelihood of rejections, they will happen. What matters more is ensur- ing processes are in place for review- ing and addressing them in a timely manner. Requiring staff to address
16 ASC FOCUS MAY 2021 |
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rejections within 24 hours is a valu- able best practice. Another critical aspect of sched- reconciliation
ule charges are submitted.
is ensuring all Reconcil-
ing all implants used during proce- dures is particularly important. Since ASCs purchase implants upfront, fail- ure to bill for them will cause a cen- ter to lose revenue—potentially a lot of it. Yet it is common to see instances when implants are not captured during charge entry. To better ensure implant reconcilia-
tion, ASCs should document implants purchased in the inventory module of their practice management system. This process will allow staff to print an implant log and cross-reference it so every implant is billed. In a similar vein, ASCs are increas- ingly incorporating pain blocks into cases, especially for orthopedics cases. Pain blocks are covered by Medicare
and most managed care contracts, so they should be billed but are often omitted from claims. Pain blocks are typically performed
by anesthesia providers. When a sur- geon finishes a case with a pain block, they might not mention the pain block in their dictation. If the billing team is unaware that a pain block was admin- istered, it could easily be left off the claim. While a single missed billing of a pain block is not likely to make a significant difference on the reim- bursement for a large orthopedic case, repeated omissions will add up. Consider these steps to help reduce
the likelihood of missing an opportu- nity to bill for pain blocks. If you know a pain block will be ordered with a pro- cedure, include the block's code in the schedule. Oftentimes, a pain block is added during a procedure. In these instances, the business office should add an alert in the practice manage-
The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.
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