It’s no secret that a healthy revenue cycle is the lifeblood of a thriving ambulatory surgery center (ASC). However, proper management is a must for keeping a steady cash flow. Without close supervision in each step, your surgery center can fall prey to common revenue cycle management (RCM) pitfalls that wreak havoc on your bottom line.
Tackling the revenue cycle may seem impossible, but building a solid action plan can help your team. Fortunately, many revenue cycle red flags are easy to find. To help you get started, we’ve spotlighted the four most common RCM mistakes we see in ASCs.
1. Lack of Patient Eligibility Verification
A simple oversight in the first step of your revenue cycle can snowball into a major revenue leak. Collecting patient information and verifying details with insurance carriers is a time-consuming process. However, it could be the difference between getting paid faster and adding another bill to your A/R.
The good news is that the solution is often simple. Submitting a clean claim starts with error-free patient information. Even a mistake as small as a misspelled word can precipitate a denial. Ensure your team triple-checks every detail of each patient’s insurance coverage — policy status, cost-sharing structures, prior authorizations, and other relevant policy details.
2. Incomplete Procedure Documentation
As an ASC, your claims will almost always be more complex than the standard office-based physician practice — complexity doesn’t have to mean inaccuracy. Set your coding team up for success by training and continually reminding your physicians of documentation best practices. Root out any causes of misalignment contributing to poor revenue capture: individual shorthand, illegibility, and other miscommunications between providers and coders.
Accurately documenting every detail of a procedure relieves the stress of translating clinical reports into billable codes and leaves you one step closer to getting reimbursed.
3. Missed Billing and Coding Errors
Like most healthcare practices across the country, you’re busy. When your team focuses more on checking boxes than guaranteeing accuracy, billing, and coding errors inevitably start piling up. From complex coding modifiers to regular changes in diagnosis and procedure codes, your team may not have the bandwidth to keep up with billing demand. And you’re not alone — an estimated 80% of medical bills contain errors, according to Medical Billing Advocates of America.1
Bringing in an extra pair of hands could be the best move. Your revenue cycle deserves the same level of attention and care you provide your patients. An expert ASC-trained billing team may be the key to taking your billing practices from good to great.
4. Leaving Rejected Claims on the Table
When claim rejections happen, it’s critical to have an action plan in place to resolve the issue immediately. This process may require additional time and resources, but the cost far outweighs the consequences of doing nothing. Train your team to be prompt when rejections come through, and make a concerted effort to dedicate additional staffing efforts to submitting clean claims the second time around.
However, this may not be feasible with an understaffed or inexperienced billing team. In this case, partnering with an outsourced RCM provider would alleviate the burden on the billing office while ensuring your ASC gets paid in full for services.
In addition to profitable revenue streams, you will also see improved billing transparency. Patients appreciate understanding their financial responsibility on the front end, meaning higher satisfaction and a greater chance of getting paid sooner. The Academy of Healthcare Revenue found that providers have a 70% chance of collecting patient payments at the time of service — but that figure drops to 30% after patients walk out the door.2
No matter where your ASC is in your RCM journey, the in2itive experts are here to help. Our billing and coding teams are specially trained to navigate the challenges and complexities of the ASC revenue cycle. Partner with in2itive to give your revenue cycle the dedicated attention to propel your ASC to greater profitability.
Need an experienced partner to drive lasting revenue growth? Let’s talk! The in2itive team can meet all of your revenue cycle management needs.
- Gooch, K. (2016, April 12). Medical billing errors growing, says Medical Billing Advocates of America. Becker’s Hospital CFO Report. https://www.beckershospitalreview.com/finance/medical-billing-errors-growing-says-medical-billing-advocates-of-america.html
- Williams, K. (2018, July 12). Address Patient Financial Risk in Pre-Service to Boost Revenue and Earn Loyalty. Healthcare Financial Management Association. https://www.hfma.org/revenue-cycle/financial-counseling/61208/