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Upcoming challenges for Ambulatory Surgical Centers and how to overcome them

As ASCs observe a period of deteriorating reimbursement, regulatory changes and challenges, numerous ASC facilities are trying to guide their medical billing and coding team through budgetary crises.  Experts in the field are looking for feasible solutions that will align their reimbursement with services provided.

The first and foremost step to improving ASC billing and collections starts with ensuring the insurance verification, registration, collection of co-pays/co-insurances and deductibles at the time of providing service, COB forms and knowledge of a charging error rate. To overcome the present and upcoming challenges ASCs should maintain a goal of getting 94 percent of claims to the insurer within 24 hours.

Tough issues that slow down the growth of ASCs must overcome such as utilization of the National Correct Coding Initiative, comprehending the insurer’s codes, claims matching, missing data and unbilled reports.

Some of the key challenges include:

Precise cash posting is important

Keep in mind that the role of the first responder is crucial, as they identify improper payments and log denials and zero pays. They are the ones who control a large range of processes, which includes cash posting, system balancing, denial management and follow up.

Focus on managed care contracts

Managed care contracts are one of the most critical elements ASCs should focus in the coming days. Things to look into are EDI and EFT requirements, reimbursement procedure, rates and implants and multiple procedure billing.

Collection goals

As priority, ASCs must always set collection goals. They must be based payor and case mix, days in A/R, net collection as a percent of gross charges and more. Remember that you as an ASC facility owner have to look under the hood and give your billers and coders realistic expectations. And one efficient way to resolve this is via an ASC medical and billing service provider.

ASCs must pay close attention to various reasons for denials, take backs and out of network reimbursement. Best practices, such as an electronic insurance verification benefits solution, measure the performance and churn out accurate statements and reports, which can facilitate a more fluid and efficient ASC billing and coding process.

From a regulatory point of view, to overcome the upcoming ASC medical billing and coding challenges ASCs should pay attention to the new emergency preparedness guidelines that surveyors are using. Even though emergency preparedness is just one of many coverage conditions, the surveyors might focus on it as it is recently revised. And as always, ASC facilities should make sure that they comply with Medicare rules and regulation, which won’t deny them reimbursement and align their ASC medical and billing duties to experts in the field.

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