ASCs face complex billing challenges that can lead to claim denials, payment delays, and cash flow issues. By implementing accounts receivable best practices, leveraging modern technology, and closely monitoring performance, ASCs can improve collections, streamline revenue cycles, and better ensure complete reimbursement.
Keeping accounts receivable (A/R) under control is key to ensuring ambulatory surgery centers (ASCs) receive the reimbursement they’re owed. However, the complex nature of ASC billing can introduce a variety of obstacles that hinder effective A/R management. Taking these challenges head-on without a strong A/R strategy can lead to claim denials, payment delays, cash flow problems, and more issues that strain the bottom line.
Thankfully, following some A/R best practices can help center leaders stay one step ahead of ambulatory surgical center billing issues and support a steady revenue stream. With this in mind, let’s look at how inefficient A/R can hamper revenue cycle management, how ASCs can improve accounts receivable, and how performance monitoring can help keep A/R days down.
The Bottleneck Effect of A/R on ASC Revenue
In simple terms, accounts receivable represents the money owed to your ASC for services already delivered to your patients. Think of A/R like outstanding credit: The hope is that your ASC will receive the owed payment in a short timeframe, which is usually measured in days. The smaller the number of days in A/R, the more efficient your ASC is at collecting money you've earned.
However, keeping that figure down can prove difficult for many reasons. For example, ambulatory surgical center billing is complex, so completing accurate documentation required by payers can be an issue. Even the smallest error in billing ASC claims can result in a denial, whether that’s due to a simple coding mistake or failing to account for a change in payer policy.
Reimbursement structures differ from payer to payer — the Centers for Medicare & Medicaid Services (CMS), for example, may bundle certain procedures, while insurance companies may require individual line items for each service. The evolving nature of structures and rules makes it difficult to keep track of the most current billing policies and requirements.
It’s also common for reimbursement rule updates to roll out on a frequent basis. These changes may be related to stricter compliance requirements, annual updates to coding, third-party payer contractual adjustments, and more. Not keeping up with these changes can lead to poor payment accuracy and increased claim denials.
Changes to rules aren’t the only issue, though. ASCs also need to submit claims and post charges as soon as possible. The complexity of ASC billing can slow down these processes, but so can outdated, paper-based systems and aging, inefficient legacy technology. This can bloat A/R days and create an unnecessary bottleneck that directly impacts profits and overall center viability.
On the patient-facing side, it’s important to have clear, effective collections systems in place. For example, staff need to know how to collect copays, deductibles, and coinsurance payments upfront. For pre- and post-procedure collections, patients need a way to submit payment easily and seamlessly. Following up on payments or sending automated alerts can help keep outstanding bills top of mind and better ensure your ASC gets paid.
Not to mention, when financial responsibility falls to patients, it’s important to understand they may have challenges in affording their medical costs. Delays in patient payments will grow A/R and make it more difficult to collect what your ASC is owed. In this case, you need to establish criteria to assess when an account has spent too long in A/R that it either needs to be passed over to a collections agency or written off.
Finally, denied claims often fall by the wayside amid other priorities. If you have a slow, tedious, or ineffective appeals process, it can be a burden on staff and a time-sink that affects productivity and further balloons your A/R. If you’re not monitoring A/R appropriately, you may not even realize that denied claims aren’t being managed properly or appealed in a timely manner.
Best Practices to Improve Accounts Receivable
With so many obstacles in the way of achieving efficient A/R, you may not know where to start. Whether you’re revising your current A/R strategy or developing a new one, here are some best practices that can help put your ambulatory surgical center billing on the path to improvement.
- Develop clear coding guidelines and quick reference cheatsheets. Since billing processes can change frequently, it’s critical to have rules documented, accessible, and easy to understand at a glance. Reference material should outline coding and billing policies for every payer — from CMS ASC billing guidelines to commercial/private payer rules — and include instructions for modifiers and where to use them for each payer.
- Emphasize the importance of comprehensive surgeon documentation. Surgeons must understand that complete documentation of their procedures is key to coding accurately and to the highest level of specificity. When information is lacking, missing, or unclear, it can result in claim errors or delays, which can impact how quickly they get paid, too.
- Collect copays and deductibles upfront when possible. Establish clear rules around providing estimates and collecting copays, deductibles, and coinsurance payments upfront. Staff should be able to quickly reference guidelines that explain which payers and procedures require payment upfront and what payments need to be collected post-procedure.
- Leverage modern technology that can streamline collections. Digitize paper-based systems or upgrade outdated technology where possible. It should be easy for patients to submit payments on the front end and for staff to navigate collections on the back end. The more up-to-date and friendly the user interface, the better.
- Use payer portals and clearinghouse solutions when available. Integration makes everything easier. By connecting with payer portals directly and leveraging clearinghouse solutions, you can exchange all necessary data between companies and track interactions with ease, which can speed up claim submissions and collections.
- Implement follow-up processes that can drive rapid resolutions. You need a way to pursue non-payments and erroneous payments. Some systems can notify payers about outstanding payments to help receive owed amounts. Automated systems can also trigger alerts at time-based intervals as a reminder to file an appeal after a denial.
- Keep track of A/R separately for each payer. While it can be useful to look at A/R holistically, getting granular detail and separating A/R by payer will help you better identify where issues are cropping up and why. This can better enable you to take targeted corrective actions.
- Closely monitor all claims and ongoing payer correspondence. Having a system to track all billing ASC claims and follow up on the status of payments with payers is essential to making sure nothing falls through the cracks.
- Put an escalation process in place. When all else fails, make sure you have a process established to escalate payment issues to your state's insurance commissioner or an attorney for arbitration. It’s best to have this structure in place ahead of time so you can execute it when necessary.
- Lean on vendors and their expertise to help simplify insurance coverage verifications. Given the complex and evolving landscape of ambulatory surgical center billing, partnering with ASC experts can help you navigate insurance coverage, better understand CMS ASC billing guidelines, and improve your A/R.
- Include billing in patient satisfaction surveys. Seek patient feedback on all aspects of their experience, including billing and payment processes. Doing so will help you understand what is impacting patient collections, so you can develop a plan to make payment easier and friction-free.
Creating an A/R strategy that leans on these best practices is key to streamlining the revenue cycle. But how do you know if that strategy is working?
How to Measure A/R Strategy Success
ASCs need a way to practically assess whether efforts to improve A/R are effective and achieving their intended goals. This is where A/R monitoring can help.
First and foremost, clearly define how you want to measure your A/R. This includes identifying and setting key performance indicators (KPIs) and related metrics. Then, you can use a monitoring solution to track and measure against these benchmarks. Monitoring tools can allow you to track performance by payer type, by individual payer, by individual staff member, and more. Pairing this data with robust analytics capabilities can help you more efficiently and effectively identify areas of ambulatory surgical center billing improvement.
Fast, clean claims should be the expectation. A/R monitoring can flag when this isn’t happening and help you narrow down where things are going wrong. With actionable analytics, you can then address issues quickly and comprehensively, whether the issue is related to problems with documentation, coding, or a lack of follow-up.
Monitoring can also help you identify when billing processes need to be revised. It can enable you to review unpaid claims on an ongoing basis, conduct internal audits, and review codes being submitted, providing a clearer picture of your overall billing and A/R performance. Learn from the challenges you uncover, and conduct training sessions that target these obstacles. In addition, take time to educate staff and surgeons on their impact and role in A/R and why it should matter to them.
Managing all these efforts can be complex and intricate, but there are options to make it easier. For example, an ASC EHR that includes revenue cycle management and analytics capabilities can simplify and strengthen the entire ASC billing process. Such solutions can help you track collections, analyze trends, measure performance, and implement adjustments to improve your ASC's A/R. Bringing all aspects together under a single pane of glass makes it easier to oversee billing ASC claims, optimize financial performance, and ensure every dollar is collected.
Alternatively, you can save yourself the A/R headache by outsourcing revenue cycle management to a partner with ambulatory surgical center billing expertise. This way, you don’t have to worry about the many complexities plaguing the modern ASC landscape and can gain some much-needed peace of mind knowing that your revenue cycle is being managed and optimized by a team of ASC experts you trust.
Improving A/R and Your Ambulatory Surgical Center Billing Performance
Payment delays and denials are unavoidable, but it is possible to greatly reduce them. By following best practices, developing a proactive strategy, and measuring performance, ASCs can maintain an efficient and streamlined revenue cycle that keeps A/R days to a minimum.
Looking for more ways to improve your ASC's revenue cycle? Learn how to avoid denials and develop an effective appeals process by watching this on-demand webinar on boosting ASC collections.
