Is Your Billing Team Performing Optimally? Take a deep dive into your processes to decide BY CARYL SERBIN, RN


our ASC is well-positioned in the community.

It has a good

reputation, as do your providers. Your caseload is steady or perhaps growing. You have a happy, busy staff. Your budget, however, is on track for expenditures but not projected income. Your investors are questioning why dividends are small or non-exis- tent. Why is your center not achieving its financial potential? To answer these questions, your cen- ter must take a deep dive into the work- ings of your billing process and deter- mine how well these tasks are being performed. The potential for revenue- related problems and leaks is present in each area of the revenue cycle.

Areas Indirectly Affecting Reimbursement Some areas that might affect consistent and optimum reimbursement are likely not

responsibilities of your billing

staff. These include your fee sched- ule, managed care contracts, financial policies and payer mix. Evaluating these areas will help you determine whether they are negatively affecting cash flow. Assess your fee schedule to deter- mine if your fees are commensurate with your geographical location and sufficient to cover costs and meet your projected profit margin. In addi- tion, assess your managed care con- tracts to ascertain whether rates are sufficient to meet procedural costs and equitable to other reimbursement rates for your area. It also is important to review your financial policies and procedures to determine whether they clearly outline your center's manage- ment of areas that directly affect reve- nue, such as upfront collections, self- pay patients and payment plans. Audit

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to verify that policies and procedures are being enforced. Finally, evaluate your payer mix. Determine the percentage of cases being performed according to payer, recognizing that a preponderance of low-paying and/or delayed reim- bursement payers (e.g., Medicaid, workers’

compensation, liability

cases) can adversely affect a consis- tent revenue stream.

Areas Directly Affecting Reimbursement (Pre-Procedure) Monies owed are easier to collect prior to the service than on the back end. To perform successful

upfront col-

lections, start with insurance verifica- tion to identify the amount of expected reimbursement

from payers and

patients’ likely financial responsibil- ity. Auditing your insurance verifier’s performance for timeliness, complete- ness and accuracy is essential to deter- mining if they are gathering the infor-

mation needed for financial counseling and upfront collections. Next, evaluate your financial coun-

seling. This process informs patients about how much their insurance com- pany promised to pay on their behalf and their personal financial respon- sibility. Provide this information to patients at least 3–5 days prior to their date of surgery. In addition, inform patients of all payment types offered by your center and obtain a commit- ment on how they plan to cover their responsibility on the date of surgery. Timeliness and proficiency of your financial counselor can be measured by the success of upfront collections and the number of promissory notes or payment plans issued. Collecting the patient's financial responsibility prior to the procedure is the final essential process. Its success largely depends on how well the pre- vious processes were performed. Prior to surgery, your financial counselor

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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