In every ASC, there will inevitably be challenges somewhere within the revenue cycle. While they may differ from center to center, we have seen common challenges amongst centers prior to partnering with in2itive. Let’s take a look at 5 of the common challenges we have seen within the revenue cycle, and our tips for combatting each.
You are seeing consistent denials.
Denials are okay - in fact, you will inevitably see denials at some time or another. (Did you know the industry standard is 5% or less for denials?) What isn’t okay is seeing the same codes consistently denied and not trying to understand the why behind it. Denials cause a disruption to the billing process, and can cause headaches for billers.
Get ahead of the curve by first posting the denial to the patient account as 0-pay once received for tracking and trending purposes. Next, move on to creating a denials spreadsheet that allows you to track all incoming denials - this includes tracking the payor, which code was denied, the reason for the denial, and any other relevant information. From here, you will be able to look back to find trends in your denials; leverage this information to see consistent denials by payor, as well as the denial cause. This information will be incredibly insightful to see commonalities that you can then tackle to reduce your denial rate.
Your team isn’t consistent in their patient follow-up - or it just isn’t happening at all.
Let’s be honest - patient follow-up can be awkward. Asking someone for money is rarely a fun experience, but there are ways to make the conversation easier and the expectations clear. First and foremost, ensure your Patient Follow-up team is properly trained and HIPAA compliant. Before teaching them the in’s and out’s of your patient payment policy, go through it with a fine tooth comb, and come up with a policy that your entire team - physicians, board, etc. - is on board with. Without all parties buy-in, you will see cracks in the policy and expectations not upheld.
Once your policy is finalized, train your team and then train them again. Make sure to equip them with any answers they may need - payment plan terms, exceptions (if any), when to turn over to collections, etc. It is important to stick to a firm and consistent plan so patients don’t learn what they can get away with to avoid paying because policy isn’t implemented at your center.
Something to consider: a tiered payment plan structure. The fact of the matter is that a $200 bill shouldn’t be treated the same as a $2,500 bill. Creating a tiered payment plan allows patients with larger balances to have a longer plan, while smaller balances have shorter plans. For example, a $500 balance will receive a 2 month payment plan while a $2,500 balance receives a 10-month payment plan; in the end, both plans equate to a $250 payment per month to have a fair balance for all patients.
Audits aren’t being performed.
Audits are essential. In some centers, auditing may not be in place whatsoever - and that is okay! It is never too late to begin implementing audits, so start by determining the frequency in which you will have audits performed. While we suggest you audit your cases quarterly, this is not always feasible. At the minimum, an annual audit is crucial to catch errors, omissions, or other discrepancies, and implement feedback based on the findings. By auditing on a more frequent - quarterly - basis, errors will be caught earlier on, and there will be less room for falling off of benchmarks.
When choosing your 3rd party auditor, we suggest using 2 or more companies and rotating the provider each audit to reduce bias and allow a fresh set of eyes on your cases. Take a look at our coding audit solution here to learn more.
You’re calling patients to let them know - surprise! - they must arrive to their appointment next week with $1,500 to hand over. And, well, they’re not too happy…
The financial consultation prior to a procedure can be a tricky conversation that may upset patients, and we can’t necessarily blame them. Keep in mind that you are most likely calling patients during their work day, asking for a possibly large amount of money, for a surgery they may already be less than thrilled about. Ensure your team is giving the proper consideration to how the patient may feel in this situation, and give grace while still sticking to your center’s financial policy. Chances are, no one will be jumping up and down to hand over hundreds of dollars, so coming at them with kindness will improve the situation from the start.
A key factor in handling this challenge successfully? Ensure your Financial Consultant role is not entry level. This position requires a kind and compassionate individual who is patient and willing to spend the time answering questions the patient may have in order to build trust and a level of comfort. An individual with experience in customer service is ideal, and annual HIPAA training is a must. Make sure your Financial Consultants are well educated in the options available to patients, and know all policies in place so they can communicate this clearly and confidently to the patient.
You receive prior authorization on a patient’s scheduled procedure, but then a slight change to the procedure results in a new code… that hasn’t been approved.
We know, you can’t predict the future! While we can’t say for certain a code will still be relevant after a procedure is performed, we can be proactive in avoiding the chaos by pre-authorizing the planned procedure code, as well as a group of similar codes that may be possible outcomes. By spending this extra few minutes getting the additional prior authorization, you can save yourself (and many areas of your revenue cycle) the headache of having to go back to the starting point when a code is denied for lack of authorization.
Remember - this is a marathon, not a sprint. Don’t worry if you face one or all 5 of these challenges; it is possible to turn each one around with time, patience, and persistence. We recommend choosing one area - be it the first challenge in your revenue cycle or the one causing the biggest upset - and implementing a solution before moving on to the next. This way, you can ensure all kinks are ironed out and any policy updates communicated and implemented effectively to withstand the test of time.