RCM process improvement in ASC

Ambulatory Surgical Centers(ASCs) must verify insurance, get authorization, and then submit a request when filing a claim. When done right, revenue cycle management (RCM) helps the medical service get paid as quickly as possible. 

However, healthcare insurance providers deny an average of 17% of in-service claims. Regardless of your RCM's current strength, there are key areas of improvement that will reduce claim denials and boost your practice's revenue.

Here are the top RCM improvement areas to focus on in your ASC.

Ensure your ASC Billing Staff or Outsourced RCM Provider Understands Authorization    

Patient representatives will sometimes give an inaccurate go-ahead regarding authorization. The amount of shifting information in medical codes even confuses medical practices of repeating procedures. Your billing resources need to understand payer contract limitations. Ensure they know what requires authorization and how to determine validity. 

Inform your surgeons what treatments a patient is authorized to receive. Sometimes, medical emergencies force surgeons to perform necessary operations outside of the scope of the original authorization. In such cases, surgeons must communicate these changes to billing staff.

Manage Patient Payment Options

When dealing without-of-pocket expenses, the best outcome is for patients to pay 100% of these fees. However, financial and communication limitations ensure that a percentage of clients will always struggle to pay on time. A recent survey shows that 54% of Americans have defaulted on their medical debt. To avoids training the patient/clinic relationship, communicate early. 

Let patients know their options and expected fees. When in doubt, state that you don't see the price or shoot for a high estimate. Expectations influence reactions. Also, make it easy for patients to pay. Set up a direct payment plan and offer prompt-pay discounts.  

Adopt Automated Verification and Billing Systems

Modern technology excels at automatic verification and tools to ensure patients' eligibility and search for authorizations. Additionally, systems can check codes and alert staff of a potential claim error before submission. 

Consider switching to an automatic system that sends patients notifications to avoid late bill submission. Some technology will instantly inform patients of changes before the procedure. Systems can automatically send notifications to the practice once a client opens an email/text or pays a bill. This knowledge lets ASCs adapt to the patient's situation and plan accordingly. 

Monitor other Sources of Insurance Denials 

Include the authorization number when submitting a claim. Doing so helps avoid unwarranted denials. However, quick authorization does not guarantee acceptance. Individual clinics have unique policy requirements. Clinics must understand these requirements before submitting a claim. Similarly, provide your physicians with these policy stipulations to avoid costly oversteps. 

Practices can minimize confusion by promoting specialized forms of treatment. Small ASCs especially should feel no obligation to advertise beyond their comfortable limit. Focusing on a few procedure types helps prevent numerous requirements from overwhelming your staff. 

Check CPT Code Changes 

Check to see if CPT codes have changed since the scheduling of a procedure. If these codes have changed, see if the payer offers retroactive authorization. Some payers will maintain the retroactive offer permanently. Others have tight timetables of a few weeks or 72 hours from the service date. If ASCs fail to get retroactive authorization during the set time frame, providers will deny claims. In such cases, an authorization may be impossible. 

Hire a Medical Collections Billing Service

Professional billing and collection services make RCM much easier. ASCs that hire such a service doesn't have to worry about inexperienced staff struggling with repeated denials. Professional billing services allow ASCs to redirect their staff power toward providing superior client care. 

Plutus Health makeshift easier for ASCs to avoid denials. If you struggle with billing, collection, and overall RCM Management, our expert team will get the fastest reimbursement possible and increase your practice's performance.

Key Takeaways

1. Inform your staff regarding authorization standards. 

2. Give patients options in terms of payment and inform them early of their obligations. 

3. Adopt automated processes to streamline informing patients and verifying benefits.

4. Check standards other than authorization like clinic policy requirements. 

5. Ensure CPT codes are the same as when you scheduled the procedure. 

6. Hire a professional billing service to benefit from a consistently high-quality RCM Process