Challenges with documentation in ASC billing

Insurance limitations and rising healthcare costs see more individuals turning to outpatient surgery for high-quality care at a low cost.

The current market

In recent years, the ambulatory surgical centre (ASC) market has grown rapidly. Because of insurance limitations and rising healthcare costs, more individuals are turning to outpatient surgery for high-quality care at a low cost. Recent reports, however, clearly show that ASCs continue to face numerous challenges in terms of improving revenue performance.

The dented reality

1. Rise in the number of accounts receivable (AR) days:

A/R is the average number of days it takes an ASC to collect payments for services provided. Days in A/R are one of the primary performance indicators used by ASCs. Becker's ASC Review stated that the typical days in A/R for ASCs is 32, based on VMG Health data. Among the many factors that influence AR days are treatment scheduling, patient pre-registration, medical coverage verification, patient financial counselling, patient payment plans, and patient collections. Setting up a patient funding solution that pays within a few days of a procedure, according to the recent Becker's ASC Review report, can also reduce days in A/R. This will safeguard the centre if patients fail to pay.

2. Cancellations:

Cancellations have long been a major source of concern for ASCs. Because of the high out-of-pocket costs for elective surgery, many patients who have their surgery cancelled may not reschedule because they are rethinking their decision to incur the expense. Same-day surgery cancellations have a tangible, negative financial impact because they are unable to fill the open OR with yet another surgical procedure but should still incur their overhead and labour costs.

ASCs must work to identify the causes of the cancellations and take appropriate steps to address the issue. Cancellations can be reduced by maintaining ongoing interactions with patients and tracking changes in the patient's medical status. Trying to implement patient financing options is another recommended strategy.

3. Surprise billing:

Patients are increasingly receiving supplemental bills from out-of-network providers, despite the fact that they've paid their co-pays and deductibles. In fact, surprise billing is a nationwide problem, and many states have passed legislation to prohibit it. It is advised that providers operating in these states understand these laws in order to avoid lawsuits. ASCs should also be cautious of unexpected billing, or they risk losing patients.

According to a Becker's ASC Evaluation report, providers can protect patients from surprise billing by doing the following:

  • Check to see if anaesthesiologists, pathologists, and lab professionals are in your network.
  • Inform the patient if these professionals cannot be brought in-network, in which case these additional charges will be added to the patient's bill.

4. Managing and maintaining payer contracts:

ASCs face numerous challenges in handling payer contracts, which are frequently subject to changes. Payers have different rules and conditions for care plans, particular geographic determinations (LCDs), preventive care, bundled payments, and so on. The American Association of Orthopaedic Executives (AAOE) has issued the following recommendations in a recent report:

  • Breakthrough narrow/closed networks by explaining why the surgical centre is beneficial to the payer's network - emphasise unique service benefits, geographic advantages, clinical/treatment perks, and out-of-network patient counts and referrals.
  • Consider a combination of direct commercial payer agreements as well as both primary and secondary complementary payer arrangements.
  • Concentrate on any worries about contract language.
  • Contracts should be reviewed on a regular basis to maintain track of modifications and contract expiry dates.
  • Understand the rules of individual payers.

5. Monitoring of coding changes:

An even more major concern for ASCs is keeping a tally of CPT code and ICD-10 code changes. The American Medical Association (AMA), for example, added 170 new codes in January 2018, revised 60 codes, and deleted 82 codes. ASCs must be aware of and implement such yearly changes. Every October, ICD-10 codes are also updated. These new codes should be incorporated into ASCs' software systems. Working with an experienced medical coding company can help you stay on top of code updates and put them into action to guarantee error-free claim submission and precise ASC medical billing for maximum reimbursement.

The solution at hand

Companies that are considering outsourcing the medical billing to a seasoned service supplier can guarantee complete guidance for all of these tasks, assisting ASCs in receiving payments faster and reducing days in AR. These businesses have instructed coders and billing experts who can ensure that claims are submitted correctly. Their team will examine accounts, identify those that have issues, and expedite their resolution. They will review denials and file appeals to reduce days in A/R. Experienced firms also offer reports on business intelligence and performance-based analytics. With higher patient deductibles and changes in healthcare, trying to seek expert external help for ASC medical billing and coding will help to improve collections and increase the overall bottom line.

Hariharasudan is the CEO & founder of 24/7 Medical Billing Services, a revenue cycle management company that helps practices boost their practice performance & increase their revenue through custom billing solutions. Drop an Email to Hari here to know more