Improve your ASC's ability to submit clean claims with these 10 tips
What makes a claim "clean?" A clean claim is never rejected. It does not receive any type of denial. It does not need to be filed more than once because of errors. When a claim is clean, it goes out an ASC's door, requires no additional work from your staff, and is paid correctly.
Essentially all ASC key performance indicators (KPIs) are impacted by how fast an ASC can get claims out the door. If a claim is dirty (i.e., unclean) and takes an extended period to be paid, days in accounts receivable (AR), AR greater than 90, and denials are going to increase.
When you get out clean claims, staff productivity will increase. You may be able to reassign staff to other tasks or even reduce staff. You will save on the expenses associated with re-working claims, such as postage and printing documentation. Finally, having a high clean claim rate will help you hit all your ASC's financial objectives and be in a better position to stay on budget and make consistent distributions to your owners.
ASC Clean Claims Best Practices
Follow these 10 tips to improve your ASC's ability to submit clean claims.
1. Engrain the importance of clean claims
For the reasons noted above and others, clean claims are vital to an ASC's financial success. Everyone involved with getting a clean claim out the door in a timely manner — from physicians to coders and billers — must understand the pivotal roles they play. They must also understand and fully appreciate how shortcomings, especially those that are ongoing, can have significant short- and long-term effects on an ASC's financial viability.
2. Strive for 100%
Achieving a 100% clean claim rate is likely to be impossible. Even if an ASC always does everything right with its claims, payers inevitably deny clean claims. It's not unusual for an ambulatory surgery center to have a claim denied and then have that same exact claim processed upon resubmission.
With that said, there's no reason ASCs should not target a 100% clean claim rate, even if efforts will inevitably come up short. SIS Revenue Cycle Services' clients typically see an average clean claim rate of around 98%. What matters is working to improve clean claim performance every month. Scrutinize rejections, denials, and delays and then implement fixes to reduce the likelihood of these occurring again.
3. Develop detailed clean claim processes
There should be no question about any of the steps staff are expected to take to best ensure the complete, accurate completion of claims. Make sure your processes detail these steps and do so in an easy-to-follow manner. Help staff follow these processes by providing "cheat sheets" and other resources.
New ASC staff members should be able to quickly understand the processes your surgery center has in place and their responsibilities in completing these processes. In addition, address what staff should do if they have a question or concern about information for a claim. Staff should feel confident that every claim going out the door is as clean and complete as possible.
4. Be prepared to change your ASC processes
While detailed processes are essential, just as critical is your willingness to revise these processes when warranted. You should do so whenever payer guidelines and roles of team members change as well as when you identify problems and/or opportunities for improvement. Just because a process works now doesn't mean it will always work or work as well as it once did.
Do not hesitate to revise processes whenever you can make them better. Train your ASC staff when you change processes and monitor staff performance to ensure new processes are followed properly and consistently.
5. Hold staff accountable
For ASCs to maintain financial success, their business office must deliver consistent results. While one hopes that staff members will always perform their jobs to the best of their ability, holding staff accountable to following processes and achieving objectives can help ensure a higher level of execution. If performance suffers, and efforts to turn matters around prove unsuccessful, staff must know there will be consequences.
6. Support staff
Surgery centers can help their staff succeed in their roles by providing ongoing support. This can take many forms. ASCs can invest in sending team members to state or national meetings (e.g., Ambulatory Surgery Center Association Conference & Expo); allocate funding for certifications, online courses, and webinars; and purchase books, manuals, and cheat sheets. Ask staff what they need to improve their performance and succeed in their positions, and then do your best to deliver these resources. Even small investments in support can lead to significant returns.
7. Become ASC technology experts
If your surgery center has invested in technology to support its business office, work to maximize that investment. Allocate time to learn the ins and outs of your solutions. There may be new features or older functions you are not using that can make claims processing more effective and efficient.
Speak with your technology vendors and ask them for guidance. You may be surprised to learn what handy tools are already at your fingertips.
8. Seek out clean claims improvement opportunities
As has been emphasized a few times in this column, regularly assess your ASC revenue cycle performance and processes, looking for weaknesses that can be strengthened. You will likely discover areas for improvement. If you do not, that's okay. You will at least validate that you have the best possible processes in place.
However, understand that a process right for your ASC now may not be the right process down the road. Evaluate your processes and performance frequently.
9. Act fast if clean claim performance suffers
If your ASC's clean claim rate starts declining, don't wait to respond. Dive into your data and identify the cause(s). Is a single payer denying all of your claims or all claims associated with a single procedure or specialty? Are you receiving rejections for a new procedure's claims? Are denials and rejections on the rise for a specific team member? There are many factors that can contribute to a decline in your surgery center's clean claim rate. Seek them out and implement fixes ASAP.
10. Succeed as a team
Getting out clean claims is all about teamwork. ASCs with the highest clean claim rate tend to have at least one thing in common: staff who work very well together. When staff not only work hard but support one another and hold each other accountable, an ASC's performance improves. But when communication is poor and business office departments operate as silos, with staff members only concerned about their own work, this will drag down revenue cycle performance and KPIs.
Focus on building a strong team, and you're more likely to succeed. Just be careful: Allow even a little negativity to permeate your team, potentially leading to a toxic workplace, and watch your processes and performance deteriorate. If you do not address that negativity effectively, your bottom line will take a substantial hit that may prove difficult to recover from.
Partner With ASC Revenue Cycle Experts to Boost Your Bottom Line
Not happy with your clean claims rate? Other revenue cycle metrics not where you want them to be? Unsure where to turn for help? Did you know that SIS, developers of the award-winning SIS Complete software platform, offers outsourced ASC billing services? SIS ASC Revenue Cycle Services combines ASC billing experts and analytics that get clients paid what they are owed and fast. Learn more about these services and why SIS is the billing partner you should want for your ASC.
