Increasing Reimbursement for Ambulatory Surgical Center (Part 1)

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Increasing Reimbursement for Ambulatory Surgical Center
(Part 1)
How can you gain better control over your ASC's revenue cycle performance? By monitoring
key performance indicators (KPIs). This first in a two-part series identifies more than 15 ASC
revenue cycle KPIs worth tracking. It explains the importance of monitoring each KPI, offers
target benchmarks (where applicable), and identifies warning signs to watch for that may
indicate a KPI is moving in the wrong direction. Part two will share common problems that can
contribute to poor KPI performance, describe solutions to help address obstacles to success,
and provide guidance for effectively analyzing trends.
Days to Bill/Charge Lag
Common problems:
 High provider dictation days. The goal should be same-day dictation.
 Providers not responding to coding queries or amending operative notes upon
request.
 Missing documentation (e.g., pathology report, history and physical, implant log,
invoice).

 Billing team issues (e.g., lack of resources, poor time management, workflow
inefficiencies, insufficient knowledge of rules and processes).
Solutions:
 Require providers to dictate on the same day of the surgery. Implement a policy that
penalizes providers who do not dictate in a timely manner.
 Establish an efficient process for business office staff to submit requests (e.g., coding
questions, report amendments) to providers and receive timely responses.
 Closely track any missing documentation to ensure timely responses to payer
requests. Note: Do not hold up billing for implant pricing if the implant is not covered
by the payer.
 Address billing team deficiencies immediately. Improve the likelihood of identifying
issues by monitoring team productivity, days to the bill, clean claim submission
percentage, tracking of held cases, and charge entry accuracy.
Days to Pay
Common problems:
 Billing delays.
 Charge entry or demographic entry errors that trigger rejections or denials.
 Paper claim submission.
 Failure to follow up on initial claim submission in a timely manner.
Solutions:
 Review the insurance and insurance identification entered in the demographic
screen prior to claiming submission to verify accurate entry.
 Perform quality assurance (QA) review of charges prior to claim submission.
 If a payer requires paper claim submission via USPS mail, follow up with the payer
within 14 days to confirm the claim was received and is on file. Problems with paper
claims submissions can contribute significantly to an increase in the metric.

 Follow up on all claims within 21 days of submission to ensure the claim was received
and is in processing. This will also help identify denials sooner.
Specialty Volume Trending
Common problems:
Negative case volume is typically attributed to poor scheduling, cancellations, and/or declining
referrals.
Solutions:
Trend volume monthly. This will help identify whether a top-paying specialty(s) has declined in
volume. If such a decline is occurring, initiate a discussion with providers and business office
leaders to determine the cause(s) of the volume decrease.
Payer Volume Trending
Common problems:
Negative case volume is typically attributed to poor scheduling, cancellations, and/or declining
referrals.
Solutions:
Trend volume monthly. This will help identify whether a top-paying payer(s) has declined in
volume. If such a decline is occurring, initiate a discussion with business office leaders to
determine the cause(s) of the volume decrease. Pay close attention to cancellations and their
reasons.
Accounts Receivable (AR) > 90
Common problems:
 Initial follow-up not occurring in a timely manner.
 Required invoices not submitted in a timely manner.

 Claim submission errors.
 Denials and appeals not addressed in a timely manner.
 Patient balances not worked diligently.
 Balance not resolved or dropped to the secondary insurance/patient after payment
posting.
Solutions:
 Work all claims within 21 days of claim submission to ensure they are received and in
process. Confirm that the payer requires no additional information.
 If the case includes a covered implant(s) but the invoice is not available upon claim
submission, track and submit the invoice as soon as it is available.
 Perform QA review of all charges prior to claim submission to avoid errors that may
delay payment and age the account.
 Identify all denials in a timely manner and address them within 48 hours of receipt.
Submit appeals within 48 hours of receiving a low or incorrect payment.
 Treat patients balance AR as important as insurance AR. Work patient balances
consistently. Implement a process to refer patients to collections when patients are
unresponsive to outreach efforts and statements.
 Once paid by the primary payer, immediately drop the balance to the secondary
insurance or patient.
Days in AR (i.e., Days Sales Outstanding)
Common problems:
 High percentage of litigation cases, workers' compensation cases, and/or out-of-
network cases.
 AR not worked effectively or in a timely manner.
 Secondary insurances and/or patient balances not resolved in a timely manner.
 Appeals or denials not addressed in a timely manner.
 Problems associated with high AR greater than 90.

Solutions:
 Monitor days in AR by financial class to better determine offenders.
 Create reasonable benchmarks for each payer type. If even a slight increase occurs,
there are likely recurring issues.
 Review cases under the offending financial class to better identify the reason(s) for
the increase. Reviewing days in AR by financial class can help isolate the offenders
without specific types of cases skewing the numbers.
 Complete an audit of the AR to further determine the reasons why a specific financial
class has higher days in AR. Focus on the problems listed above.
Days to Dictate
Common problems:
 Provider failing to perform timely dictation.
 Provider failing to review and sign off on operative notes in a timely manner.
Solutions:
 Establish a dictation standard for each provider to follow. Rule of thumb: Dictate on
the same day of the surgery.
 Create incentives and consequences for timely and untimely dictation.
Understanding the importance of monitoring revenue cycle KPIs benchmarks to strive for, and
warning signs that may indicate suffering KPI performance is vital to ensure a highly
productive revenue cycle. The second article in this two-part series will share common KPI
performance problems, solutions to help overcome obstacles and guidance for analyzing
trends.
When it comes to ASC medical billing, Medical Billers and Coders (MBC) is one of the leading
service providers. With our 15+ years of experience in the medical billing domain and with our
proven ASC medical billing services, many surgical centers across the country have overcome
denials and underpayments. Our billing professionals not only specialize in ASC coding and

billing but also incorporate the knowledge throughout the process. To know more about our
ASC medical Billing services you can contact us at 888-357-
3226/info@medicalbillersandcoders.com

Increasing Reimbursement for Ambulatory Surgical Center (Part 1)

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