1. Separate duties in the business office. This is a key concept of internal control because it prevents fraud, theft and errors. Dividing the tasks among staff members ensures checks and balances. "Errors cause extreme delays in getting money in the door," Ms. Meredith said.
2. Ensure procedures are approved before operation. It's essential to know whether Medicare, workers compensation or Medicaid will cover the procedure.
Ms. Medicare also warned ASCs to be careful with out-of-network benefits. Understanding what plans are paying is critical information to know right away.
3. Establish a policy on benefit verification. Ms. Meredith suggested making a list of questions for employees to ask patients, although ASCs shouldn't verify too far in advance. It's also important to document with whom employees speak and at what time the conversations take place. Talking to a live person when verifying benefits is preferable to doing everything over email, she added.
It's also important to watch for policy exclusions and limitations. If uncertain, it's crucial to verify claim addresses or payor ID with customer services. Ms. Meredith said to verify what format the claim should come in (i.e., CMS 1500 format or UB04).
4. Verify registration information with patients and make any corrections immediately. Ms. Meredith tells staff at ASCs she works with to take a few more seconds to make sure they have the right address to mail the claim to. "Taking care of all of this on the front end will ensure your claim is paid very quickly," she said. It's also important to collect the patient's payment responsibility — the co-pay, or co-insurance deductible — as soon as possible.
If patient needs a payment plan, have all the papers signed at admission, she said. ASCs should bill the patient immediately after surgery for the estimated amount they owe.
5. Manage outsourced tasks. It's important to have a system in place for tracking operative report deficiency, Ms. Meredith said. It's also important to call transcription if an operating note isn't back within 24 hours, she added.
If no dictation is received within 48 hours of a procedure, an ASC's business office manager should call the surgeon. This could be considered a quality-reporting issue.
6. Monitor coding and billing. ASCs should be doing a coding audit annually, Ms. Meredith said. It is expensive, but it's also important to code properly. She suggested establishing a benchmark for when claims should be billed — for example, within 48 hours of the date of service.
7. Understand workers' compensation billing. Obtain the name and contact information of the adjuster prior to date of service, Ms. Meredith said.
It's also crucial to:
- Verify a billing address;
- Obtain a WC claim or file number;
- Attach operation notes; and
- Obtain authorization when necessary.
"Try to negotiate your payment upfront," she suggested, because "workers' compensation can be a nightmare."
8. Know your insurance contracts. Here are questions Ms. Meredith suggested to ask about insurance plans an ASC works with:
- Do you have the carrier's claims processing manual?
- Does your contract pay for implants?
- Are you supposed to use an implant supply company?
- What revenue code are you supposed to use for billing certain HCPCS codes?
- Do you have a system in place to know if you are paid correctly?
9. Have a system in place for consistent claim inquiry. Ms. Meredith said initial follow-ups should happen no more than 15 days after submission of claim. Subsequent follow-ups should come every 7 days. If claims are still being processed a month later, someone from the ASC should talk to a real person.
10. Watch claim payment posting. It's important to make sure the insurance company paid according to the contract terms. If the claim is out-of-network, ASCs need to make sure they receive sufficient reimbursement. Also, it's important to know if any refunds are due and whether they are due to the insurance company or the patient.
11. Be careful billing secondary insurances. Ms. Meredith noted that it's important to always remember to send the primary remit when billing secondary insurances.
12. Be concise with insurance company appeals. Get to the point when writing them, Ms. Meredith said. Then, call the carrier and determine if the appeal was processed correctly. Document the name of whom you talked to, as well as the date and time.
13. Bill patients immediately after surgery. Third party services can help ASCs obtain debit or credit card information so payments can be automatically deducted. Ms. Meredith said ASCs should aggressively monitor the payment plan. It's important to call and speak to the patient if payment is delinquent. "Passive aggressive behavior is not going to get you your money back," she said.
Even though ASCs want — and need — to be reimbursed, it's also important to empathize with patients struggling to make payments given this is still a difficult economic time for some. Ms. Meredith said ASCs should work with patients to come up with a payment solution fair for both parties.
14. If all else fails, hire collectors. When patients cease to make payments, and ASCs expend all opportunities to connect with them, it may be time to bring in a collection agency or attorney. Ms. Meredith suggested using the latter because she's had better luck collecting money when an attorney is brought into the situation.
15. Consider taking issue to small claims court. If collection agencies or attorneys don't work, it may be time to take someone to small claims court. Ms. Meredith said to have an ASC business manager or administrator attend small claims court hearing, and to only use a lawyer if your state's law requires it.
16. Daily reconciliation of transactions. This is a process Ms. Meredith said must occur daily, whereby transactions made in a surgery center's software system for money collected on patient accounts is tied to the deposits made into the ASC's bank or accounting program.
"It's all about the bottom line; you still need to maintain quality, but you need to understand what's going on in your business office," Ms. Meredith said. "Go back and start writing down what your protocols are for your business office, that way everyone knows what the game plan is and then they can follow it."
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