In a presentation during Becker’s ASC Review’s 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + the Future of Spine, June 14 in Chicago, Kim Woodruff, vice president of corporate finance and compliance at revenue cycle management solutions firm Pinnacle III, shared several strategies for maintaining a high-functioning in-house business office at ambulatory surgery centers.
Front office staff should input all data flawlessly and ensure accurate, timely confirmation of benefits and service eligibility before the date of service, and the day of the patient’s procedure should verify demographic information and make a copy of the insurance card as well as collect co-pays up front. This is not always easy, as “there is often a lot going on at a surgeon’s office,” said Ms. Woodruff, and often patients might not want to hand over their co-pay at the time of service. However, a pre-operative financial consult and clearly defined payment expectations can help ASCs collect what they are owed, she said.
All of these steps should also be documented by staff, she said, to have a record for the back office staff and follow-ups with patients.
In the back office, the staff’s responsibility is to quickly obtain operative notes and implant invoices to help ensure timely coding and billing, load contracts to facilitate deduction of contractuals upon charge entry and monitor electronic rejection reports. Accounts receivables should begin to follow up on claims after about 24 to 28 days, she said. “Does the payer have the claim? Does the payer need anything else to process the claim? Know that,” said Ms. Woodruff.
Once payment is received, the back office should confirm the right amount was paid, and ensure timely transfer of outstanding balances to either secondary payers or the patients. Timeliness will vary based on practice size as to how often patient statements can be billed, but Ms. Woodruff reminded attendees only sending statements once per month can add up to 30 days to some claims. Unpaid balances should be referred to a reputable collections agency.
To combat denials, it is important an ASC know which procedures are and are not approved by specific insurance carries and their plans, what pre-authorization is required for the carriers/plans that do allow ASC procedures, any frequency limitations that are in place and what diagnosis codes do not support medical necessity for which types of claims.
More Articles on Spine Business:
The Next 5 Years in Spine: The Question of Physician Independence & More
Physician Governance, Group Culture Critical to Ortho, Spine Success
Physician Involvement in the Political Process