Q&A with SIS RCS experts Yunette Ruiz and Gabriella DeSantis
Yunette Ruiz, client service manager, and Gabriella DeSantis, revenue cycle manager, for Surgical Information Systems (SIS), recently hosted a webinar on "Patient Financial Responsibility: Collecting What You're Owed" where they provided insight and guidance on the challenges associated with patient payments and how to increase collections success. The audience was highly engaged and asked great questions during the Q&A portion of the program that provided additional opportunities for Yunette and Gabriella to discuss what ASCs must know about collecting from patients.
Below are the highlights of those questions and responses provided by Yunette and Gabriella, edited for readability. To view the webinar on-demand, please visit the SIS Resource Library.
Q: How can I better encourage my staff to meet collection goals?
A: Encourage your staff to meet goals by educating them on why it is important to do so for the health of the center. You may also want to offer incentives to encourage friendly peer competition. Incentives may include prizes tied to quarterly performance, such as those based off key performance indicator (KPI) improvement.
Q: What happens if I do not follow the No Surprises Act guidelines provided by CMS (Centers for Medicare & Medicaid Services) OPM (U.S. Office of Personnel Management), or HHS (U.S. Department of Health and Human Services)?
A: You may be eligible for a fine up to $10,000 if dispute is made through the IDR (independent dispute resolution) process and you are found to be at fault of this act. The IDR process goes into effect when a bill/credit is $400 above or lesser than the estimated amount.
Q: The patient co-pay amount may depend on who submits the claim to insurance first, which can lead to inaccurate estimates. How would you suggest we handle this?
A: The best way to handle this scenario is to educate the patient upfront and emphasize that the figure you're quoting is an estimate. For a surgical procedure, patients receive services from multiple providers (e.g., ASC, surgeon, anesthesia, pathology). It could be that the surgeon's office submits their bill first. If the deductible was paid to one of the providers, like the surgeon, and then the deductible hits for the ASC's facility bill, then the patient will likely end up with a credit balance. Then the patient will need to be issued a refund so they can pay the provider. If a patient ends up with a credit balance, issue that money back to the patient promptly so they're able to resolve their financial responsibility with the provider.
Q: My state already has "no surprises" billing acts in place. What does the federal No Surprises Act rule mean to me?
A: The state rule will supersede this act.
Q: How can I better ensure my staff is communicating effectively and efficiently when discussing patient financial liability?
A: The best way to ensure effective and efficient communication is to provide the tools your team needs to succeed. This may include training modules, scripts, and/or roleplaying real-life examples as a guide. Auditing patient calls may be helpful as well to identify opportunities to provide constructive feedback or suggestions.
Q: Can I have patient's sign affidavits waiving IDR rights to balance bill?
A: Yes, you can have patients sign affidavits waiving their rights as long as it is worded appropriately.
Q: What happens if I bill patient insurance and the insurance has been terminated? Am I safe to send a bill to the patient since the insurer was terminated at the time of services?
A: Yes, you can send a bill to the patient differing from the estimated amount if the insurance was terminated at the time of service. It is a good practice to attempt to contact the patient for updated insurance information prior to sending the patient a bill. You only need to be careful in this scenario with emergency services, which are not usually seen in the ASC setting.
Q: As long as we make sure to tell patients that what they receive is an estimate and their bill could be more or less, we cannot get in trouble with the No Surprise Act, correct?
A: That is incorrect. The patient must sign an affidavit in clear, written language indicating they agree and understand that they are waiving their rights to be billed for services outside of the estimated amount. Without consent signed by the patient, you would not be allowed to bill/credit more than $400 to the patient or you may be liable for an IDR dispute. Here is the link containing the standard notice and consent document provided by CMS.
Keep in mind that the No Surprises Act only pertains to out-of-network and uninsured patients. If a patient has insurance and the estimate differs, you are safe to bill/credit the patient without a signed affidavit.