Managing accounts receivable (A/R) is an important activity in any specialty, including ambulatory surgery centers (ASCs), as it assists providers in receiving appropriate reimbursement for services rendered and includes insurance eligibility verification, preauthorization of services, capturing charges and posting payments, billing and claims submission, account follow-up and payment resolution. For an ASC, A/R is the money owed by a patient for services already provided and A/R days refer to the average number of days it takes to collect patients’ owed balances for services rendered. This measurement helps ASC revenue cycle management staff in determining where to concentrate collection efforts.
According to a Becker’s ASC Review article, common factors that influence the size and accuracy of A/R include accuracy and timeliness in posting charges and payment, contractual adjustments, correct timing of switching guarantor responsibility, pursuing non-payments or incorrect payments from payers, collecting upfront co-pays and deductibles, collection timeliness as well as policy concerning write-off of non-collectible accounts.
As ASCs are focused on providing same-day surgical care, including diagnostic and preventive procedures, revenue cycle management can be a challenge. Collection of co-insurance and deductibles before surgery is critical to accounts receivable management in an ASC.
Consider these tips to clear your accounts receivable.
Check monthly A/R reports
Analyzing monthly reports is essential for a healthy A/R, as it helps to immediately address any increase in aging buckets, average days in A/R or A/R over 90 days. Of the most common reports by payer, financial class, patient, date or procedure, payer’s report is usually the most helpful, as it lists accounts due from each payer, shows how long they have been owed and helps evaluate payer mix. Along with running monthly reports, you should also maintain a spreadsheet that recaps monthly charges and payments, month-end aging buckets, and average days in A/R. It is recommended that only 15 to 20% of your accounts receivable should be older than 90 days and primary commercial payments should be received within 60 days.
Review codes submitted to payers
Medical coding and billing mistakes can also disrupt the cash flow cycle. A coding audit, which is a review of codes submitted to payers and the comparison of those codes against what is supported in the documentation, must also be performed on a regular basis to help ensure that ASCs receive appropriate payment for services provided to patients. A coding audit can also identify instances of upcoding, which can lead to further consequences if the mistake is identified by the payer. It is also critical for the auditor to check whether the ASC’s coders have a clear understanding of current ICD-10 guidelines and can apply those rules consistently across the board for all the ASC’s case types and specialties. It is also ideal to check physician documentation deficiencies, as it impacts coding accuracy.
Internal auditing helps
An internal revenue cycle audit is another effective way for evaluating your ASC’s operations, which helps identify financial stress points, strengths, and opportunities. Regular internal auditing of each area affecting the revenue cycle should be conducted on a regular basis, as it examines, quantitatively and qualitatively, all components of the revenue cycle process. It also helps to identify what is working and what can be improved, helping your center get on track and stay on track. A successful self-audit should focus on main financial areas of the ASC such as – Reimbursement, Coding and billing, Staffing and Observation.
Review unpaid claims – It is important for billing supervisors to review every unpaid claim once in a month to make sure staff members are following up on correcting and appealing claims. Making this a normal monthly routine also ensures accountability of the work your staff is performing. Following up unpaid claims on a monthly basis allows to identify poor performance or claims.
It is also recommended to consider external audits by an outside entity at least annually and more frequently if your ASC is working to bring about significant improvements. External audits also supply an additional level of compliance and accountability for your medical coding services. Partnering with reliable medical billing companies enables ASCs to benefit from free medical AR analysis, and make an informed decision about their medical billing needs.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.