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BILLING


should provide the registration clerk with the amount of the patient's finan- cial responsibility and how the patient is planning to meet their financial obli- gation. To measure the upfront collec- tions


success, compare the patient's


commitments to pay, as provided by the financial counselor, to the upfront col- lection amounts.


Areas Directly Affecting Reimbursement (Post-Procedure) Following the procedure, certain steps must be completed properly and con- sistently to help ensure your ASC obtains appropriate reimbursement. Accurate coding is the bedrock of reimbursement. Errors can financially impact your center and put you at risk for noncompliance. Submitting claims with procedure and/or diagnosis codes not supported by the operative note puts your center at risk of a compliance audit and resulting fines and presents the pos- sibility your center is not obtaining allowable reimbursement. Coding mis- takes also often result in claim delays or denials. Establishing a denial log listing the reasons for denials will help pinpoint the number of claims denied or delayed because of coding errors. Addi- tionally, check your coder's accuracy with regular internal audits and annual audits by an independent third party. After receipt of coding information,


your charge poster should enter charges in the proper format and submit claims via your clearinghouse. Clearinghouse reports identify errors that require cor- rection. After making necessary correc- tions, resubmit claims. Finally, to ascer- tain the submission of all claims, tally the number of accepted claims listed on the clearinghouse receipt against the number of coded cases listed on the coder's report. To determine percentage of clean claims submitted, compare the total number of claims submitted to the number of rejected claims. Also, audit reasons for rejections and timeliness


seven days to a maximum of 21 days. Collectors can often obtain the status of specific claims via payer websites, but some must be contacted directly. Collection efforts should be noted in the


patient's chart, and information


of correction/resubmission and com- pare the number of claims submitted to the number of scheduled cases for the specific date.


Proper submission of claims as described above should result in timely and accurate reimbursement. Payment posting should be performed on the date of payment receipt. Your payment poster should be familiar with contract allowances. Better yet, the specific contract rates should be entered in your ASC's software, help- ing ensure that you can recognize the accuracy of payments and appropriate adjustment of fees.


Payment posters are responsible for completing the denial log and disburs- ing information to the appropriate reve- nue cycle team member to fix errors and resubmit corrected claims. The pay- ment poster also is responsible for ini- tiating the appeals process when there is a discrepancy or payment denial. To measure the proficiency of the payment posting process, compare daily bank deposit to your payment posting batch report, audit the denial log to deter- mine if it is current and all entries have been assigned to the appropriate team member for follow-up and run an aging report on claims in appeals.


Depending on the carrier's guide- lines, follow up on electronically sub- mitted claims should begin as soon as


regarding date of expected payment should also be entered in a tickler file to help ensure timely follow up. Depending on your center's soft- ware, collectors may be able to access reports on aged accounts receivable (AR) by payer to help pinpoint which accounts should be followed up on first. To measure collection efforts, audit appropriate AR reports to assess age of accounts, timeliness of follow up, claim denial management and other important processes.


Following the receipt of full and accurate reimbursement and any nec- essary and approved write-offs, trans- fer the remaining account balance to patient/guarantor responsibility. Send patient statements immediately and then every four weeks until your ASC is paid. To determine if patient collections are followed appropriately, run aging reports of patient balances and appoint a team member to follow up on them.


Stronger Staff Performance, Stronger Bottom Line When your ASC appears to be running efficiently but cash flow is less than anticipated, doing a deep dive into all areas of the revenue cycle will help determine where revenue leaks are occurring. Take the time to effectively assess whether your billing staff is at peak performance, paying particular attention to timeliness and accuracy of revenue cycle tasks. These two param- eters must be met to ensure a consis- tent revenue flow and financial success for your ASC.


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


ASC FOCUS MAY 2021 | ascfocus.org 21


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