Plugging Revenue Leaks in Your ASC

Finding a revenue leak in your facility is always a challenge. A working knowledge of your payors’ coding and billing regulations is essential, of course, but there are resources available to ease the task. In particular, your billing software’s reporting mechanisms can be extremely helpful in finding revenue leaks, as well as identifying appeals areas and possible “red flags” that might require your attention (before they draw a payor’s attention).

Revenue reports should be run a minimum of once every 30 days. Best billing practices require a turnaround time of no longer than 30 days in accounts receivable (A/R). With the technology available to the modern facility, there is no excuse to allow accounts to sit any longer, or to chance lost revenue and missed billing opportunities. It is best to assign not only an administrative person to review your reports, but also a billing and coding staff member to provide guidance and details.

Learning how to decipher the numbers helps you to get a full understanding of what really is going on in the facility. For instance, what is your ratio of appeals to submissions? Monitoring the amount of time exerted on appeals is necessary to determine what type of problem may exist. Is there a particular service being denied frequently? Has your rate of collections declined? If so, this could be an indication of changes in medical policies that have been missed, or an indication that staff training is required.

You should also monitor your individual payor contracts, and the payment rates associated with them. Such individualized data are a handy tool to deciphering expected payments in the door, as well as inappropriate payment and billing patterns.

Copies of contracts should be readily available so that the terms are easy to load into your practice management software, thereby ensuring that you are alerted if the proper payment is not received. Setting this up initially takes work — you must enter all the information into the system — but takes only a few hours to update annually.

Denials should not be allowed to be written off without a supervising signature. I’ve often personally seen facilities losing vital revenue because billers incorrectly wrote off charges that should have been paid.

Knowing where the money is coming from, and who it is going to, is also vital in an ambulatory surgery center (ASC) setting. A recent update from CMS titled, “Payment System Fact Sheet Series: Ambulatory Surgical Center Fee Schedule” helps to sort this out.

Source: American Academy of Professional Coders.

In addition to keeping track of all the reports normally followed in a practice setting, an ASC setting also requires a tracking mechanism for any of the above listed items and services your particular facility provides.

Success in revenue management is in the details. Following your A/R closely allows not only for complete and timely payments, but also provides a “first look” at what may be a growing trend or problem area in your ASC. Such proactive measures are increasingly necessary in an environment of constantly changing rules and government regulations, and help to keep your facility afloat in tough economic times while minimizing the chances for potentially agonizing payor reviews and audits.

Rhonda Buckholtz, CPC, is director of business and member development at the American Academy of Professional Coders (AAPC), the nation’s largest education and credentialing association for medical coders. AAPC provides certified credentials to medical coders in physician offices, outpatient facilities and payor environments. More than 50,000 of AAPC’s 75,000 members are certified coders, meaning they have passed a 5.5-hour proficiency test of their ability to correctly abstract medical charts using CPT, ICD-9-CM and HCPCS codes.