Published on Beckers ASC Review
By Kylie Kaczor, MSN-RN, CPCO, CPHRM, CMPE, CASC, CLSSBB, ACHE, Senior Vice President — Clinical and Regulatory Affairs, National Medical Billing Services, and Aaron Davis, PMP, ICGB, CLSSGB, Vice President — Client Operations, National Medical Billing Services
As the healthcare industry strives to financially recover from the coronavirus pandemic and continues to meet patient needs that have changed as a result of the pandemic, revenue cycle success is at the forefront. Ambulatory Surgery Centers (ASC) can set their facility up for success in this new year by focusing on three key areas: front-end operations, price transparency, and managed care contracting.
Proper capture of patient demographic information and insurance verification are key first steps in a healthy revenue cycle. Incomplete and incorrect patient demographics and eligibility can result in the misquoting of patient responsibility and can also result in rejected or denied claims which will have an immediate impact to cash flow. Many ASCs look to technology to decrease demographic error rates however, you cannot layer technology atop a broken process. Facilities should first review internal policies and production workflows and update processes where needed. Once solid processes are established, implementing technology that can accurately capture demographic information and confirm patient eligibility is one way to help eliminate claim rejections and denials, which in turn improves clean claim rates and increases cash flow.
ASCs can also increase price transparency to comply with new transparency regulations such as the No Surprises Act through the proper quoting of patient responsibility at time-of-service. Patients have become one of the primary payers in healthcare today not only due to the rise of high-deductible health plans but also due to the rise of consumerism and the ability to search and shop for services. A recent TransUnion study showed that roughly 70% of patients do not pay their financial responsibility after services have been provided and as such, ASCs must shift their focus to improve time of-service collections. To help providers collect these higher patient responsibilities, many practices are implementing new technologies and automated tools to accurately evaluate patient benefits and eligibility and produce accurate time-of-service patient responsibility quotes. These estimates also offer providers the supportive and accurate information needed to discuss personal and customized financial responsibility with their patients during financial counseling.
Offering an online payment option through portal or other mode is another service that is conducive to increasing patient collections while providing patients with transparency of healthcare cost. Some recent research suggests patients are displaying an overwhelming willingness to pay health care bills online and via mobile devices with 80% of patients preferring digital patient payments in their clinician offices. Providers should consider adopting electronic bill pay to not only meet consumer needs but to also help eliminate burden on staff and increase collections through consumer ease of use.
Your facility will also want to ensure that you are being properly reimbursed by the payers and employer groups for the services you are providing. Take time to re-evaluate your managed care contracts to ensure procedures are covered at rates that make the best financial sense for your business. While it’s important to assure payers of the value of the services you provide in the ASC setting, it is also important to make sure the managed care contracts allow for adequate reimbursement on implants and other surgery related costs. Understanding inpatient costs in the local market, as well as how much it costs to build and operate surgical programs in your ASC, can help you discern total costs. With this information, you can then negotiate contracts that produce a fair margin and position your ASC for growth.
We know that patients are becoming increasingly educated about their healthcare choices and with current legislative actions focused on price transparency, we anticipate patients will increasingly expect full visibility of healthcare costs. Many facilities are beginning to take advantage of new methods of improving front-end operations to stay ahead of the curve. Establishing a solid process, investing in new technologies and resources that ensure your organization is compliant with price transparency regulation, and automating patient demographic and eligibility capture to increase ease of use for patients will ensure your facility is meeting the needs of your patients while having a positive impact to your overall revenue.
This post was first published February 7, 2022 and was updated May 31, 2022.