Problems in These Revenue Cycle Areas Can Strain an ASC's Cash Flow
Are you looking for ways to improve your ASC's cash flow? Auditing all areas of the reimbursement cycle is necessary to pinpoint areas of concern. However, what if these audits do not reveal sufficient evidence of why the reimbursement is not what was projected? You may need to consider reviewing less obvious areas that can affect your reimbursement rate. These non-obvious areas where problems can arise which affect revenue stream are outlined below.
Note: For solutions and best practices for these and all areas of reimbursement, attend "Improving Your ASC's Revenue Cycle Operations From A to Z", presented by Caryl Serbin, RN, BSN, LHRM, and Tara Gillon, ASP, CRCP-P, at the upcoming ASCA 2019 Conference & Expo in Nashville, Tenn., May 15–18. This advanced, breakout session is scheduled for Friday, May 17, at 8:00 a.m.
Infrastructure
Infrastructure refers to business office staff and how inexperience and poor working conditions can adversely affect reimbursement.
Common Problem Areas:
Lack of appropriate work space
Insufficient staff for volume
Inexperienced staff
No business office policies/procedures
No initial in-services or continuing education
Lack of oversight/performance
Fee Schedule
Poor structuring or lack of current oversight of the fee schedule is often one of the most frequently overlooked areas that may cause poor reimbursement. Lack of a current and appropriate fee schedule may mean that the ASC's basic fees may not be sufficient to cover case cost.
Common Problem Areas:
Fees less than reimbursement rates (e.g., Medicare, managed care organization)
Fee schedule not loaded in billing system
Duplicate fee schedules
No policies or safeguards for fee schedule changes and/or additions
Fee schedule not updated or audited
Managed Care Contracts
Everyone is aware of the decreasing reimbursement rates pushed by managed care providers. Expert negotiation skills are essential when contracting. There are other challenges in this area that may be unfavorably affecting reimbursement.
Common Problem Areas:
Contracts not loaded in billing system/no access for staff
Contracts not kept current
Current contract rates lower than case cost on any procedures
Implant coverage non-existent or too low
Contracts not worth the paper they are written on
Financial Policies
This is an area that is often ignored. It is imperative that ASCs have written financial policies covering all financial possibilities that may be encountered (e.g. patient financial responsibility and when payment is due, self-pay patients, workers' compensation). However, developing these policies does not solve all of the problems.
Common Problem Areas:
No financial policies in place
Existing financial policies do not reflect practices
Lack of policy enforcement
There are numerous steps necessary to get from A (appointment) to Z (zero balance), with many areas where the process can get bogged down. Serbin and Gillon's ASCA 2019 presentation will examine every nook and cranny of the reimbursement process. Furthermore, they will provide solutions and best practices based on the presenters 30-plus years of addressing reimbursement challenges and educating ASC personnel on overcoming these challenges and improving their center's revenue stream.
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