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How to Avoid Common ASC Revenue Cycle Management Downfalls

Aug 13, 2019 | Posted by Jocelyn Gaddie in Revenue Cycle Management

HowToAvoidCommonASCRevenueCycleManagementDownfallsSteer clear of these avoidable RCM pitfalls, and you’ll save money and get paid faster.

Running a successful ASC means keeping many balls in the air. While your primary focus is patient care, productive revenue cycle management is what keeps the entire operation afloat and thriving. 

Deceptively small errors that occur during routine office tasks can have a serious financial impact on your business. Claims could be denied and deadlines missed, leaving patient care at risk.

Make sure you and your team steer clear of these pitfalls.

Don’t miss patient information—incomplete or inaccurate information means denied claims.

When a new patient walks into your ASC, they provide you with a lot of information. This information is vital for your revenue cycle management; it cannot be skipped and should not be rushed. It may be tempting when a patient comes in late for their appointment to hurry things along. However, doing so often leads to incomplete or inaccurate information, which can be expensive in the long run.

Make a point to have patients come in early to complete forms or send these requests ahead of time and review them at the time of the appointment. Misspelled names, transposed birth dates, missing digits, or invalid group numbers are the most common paperwork mistakes that will cause claims to be denied.

Don’t skip securing prior authorization. Being on top of prior authorization ensures payment for the care provided.

In the course of caring for a patient, an ambulatory surgery center physician may feel that certain procedures are appropriate for the individual they are seeing. However, insurance companies and payers may not reimburse those procedures for a variety of reasons. Your ASC can be proactive by securing prior authorization from the patient before his or her procedure. 

It is vital to discuss planned procedures with physicians, carefully research the service(s) with the patient’s insurance carrier, then review options with the patient. He or she may be required to get prior authorization before surgery. If the procedures are not covered, the patient can decide whether they want to have it and how to pay for it. These crucial conversations will help eliminate billing disputes and patient complaints.

Don’t assume insurance companies understand intent. Make sure codes and services match.

It's important to educate your team on every procedure your center provides and how to correctly match each to their corresponding insurance codes. Attention to detail is key when communicating with insurance carriers and payers. 

For example, insurance companies may not understand the difference between an exploratory cortisone shot and a cortisone shot to fill the space in an arthritic joint. Matching each service to the right code ensures accurate billing. 

Resist the temptation to skip double-checking. Wrong or missing information can lead to insurance resubmissions and reconsiderations.

Insurance companies and payers will send claims back to your office for resubmission if the claim has missing or inaccurate information, coding errors, or documentation mistakes. Reconsiderations are claims that have been denied/paid incorrectly or have errors from the insurance company. In both cases, having to resubmit claims means dedicating precious resources to fixing clerical errors and more time between performing a patient procedure and collecting payment. 

If you do have to complete a resubmission, make sure to include an updated copy along with the original claim. Be clear about why the claim was denied and spell out what has changed in order to correct the error. Point out if there was a miscommunication or mistake on the part of the insurance company or payer. Being concise, sticking to the facts, and clearly explaining why the claim should be approved will help this process go as smoothly as possible.

Don’t miss claims deadlines.

Each insurance provider has their own timeline for claims submissions. If you miss a deadline, you are putting your center at risk of being denied payment for services. Timing guidelines can be confusing with different date ranges depending on whether your center is in or out-of-network. Unfortunately, different time frames, busy schedules, and competing priorities can make missing deadlines all too easy. 

Tracking deadlines through your software and electronic calendars will help with organization and alerts, but outsourcing this work to an RCM agency can also take the stress off your shoulders.

Never deal with a revenue cycle management pitfall again.

One way to curtail missed deadlines and other common and costly downfalls within your ASC is to partner with an outside firm like in2itive Business Solutions. We specialize in full-service revenue cycle management.

Part of helping you maximize your center’s revenue cycle is highlighting common mistakes so you can avoid them before they damage your reputation or your bottom line. We can set up red flags within your electronic medical records for open claims, provide a dedicated support staff to process paperwork and claims, monitor billing, and deliver valuable documentation. 

Our team can help you streamline your processes and use analytics to determine what works for you. Imagine never again having to deal with common ASC revenue cycle management pitfalls.

If you’re ready to get a handle on your RCM, start with our RCM Audit, or sign up for a free consultation to discuss your unique situation and discuss the right solution for your business.

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