Your ambulatory surgery center (ASC) is well-positioned in the community. It has a good reputation, as do your providers. Your caseload is steady or perhaps growing. You have a happy, busy staff. Your budget, however, is on track for expenditures but not projected income. Your investors are questioning why dividends are small or non-existent. Why is your center not achieving its financial potential? To answer these questions, your center must take a deep dive into the workings of your ASC's billing process and determine how well these tasks are being performed. The potential for revenue-related problems and leaks is present in each area of the revenue cycle. Learn how to take a deep dive into your processes to decide whether your billing team is performing optimally in this column by Caryl Serbin, RN, of Serbin Medical Billing, that appears in the May 2021 issue of ASC Focus magazine.

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2. 20 ASC FOCUS MAY 2021 |ascfocus.org
BILLING
Your ASC is well-positioned in
the community. It has a good
reputation, as do your providers. Your
caseload is steady or perhaps growing.
You have a happy, busy staff.
Your budget, however, is on track
for expenditures but not projected
income. Your investors are questioning
why dividends are small or non-exis-
tent. Why is your center not achieving
its financial potential?
To answer these questions, your cen-
ter must take a deep dive into the work-
ings of your billing process and deter-
mine how well these tasks are being
performed. The potential for revenue-
related problems and leaks is present in
each area of the revenue cycle.
Areas Indirectly Affecting
Reimbursement
Some areas that might affect consistent
and optimum reimbursement are likely
not responsibilities of your billing
staff. These include your fee sched-
ule, managed care contracts, financial
policies and payer mix. Evaluating these
areas will help you determine whether
they are negatively affecting cash flow.
Assess your fee schedule to deter-
mine if your fees are commensurate
with your geographical location and
sufficient to cover costs and meet
your projected profit margin. In addi-
tion, assess your managed care con-
tracts to ascertain whether rates are
sufficient to meet procedural costs
and equitable to other reimbursement
rates for your area. It also is important
to review your financial policies and
procedures to determine whether they
clearly outline your center's manage-
ment of areas that directly affect reve-
nue, such as upfront collections, self-
pay patients and payment plans. Audit
The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.
Is Your Billing Team Performing Optimally?
Take a deep dive into your processes to decide BY CARYL SERBIN, RN
to verify that policies and procedures
are being enforced.
Finally, evaluate your payer mix.
Determine the percentage of cases
being performed according to payer,
recognizing that a preponderance
of low-paying and/or delayed reim-
bursement payers (e.g., Medicaid,
workers’ compensation, liability
cases) can adversely affect a consis-
tent revenue stream.
Areas Directly Affecting
Reimbursement (Pre-Procedure)
Monies owed are easier to collect prior
to the service than on the back end.
To perform successful upfront col-
lections, start with insurance verifica-
tion to identify the amount of expected
reimbursement from payers and
patients’ likely financial responsibil-
ity. Auditing your insurance verifier’s
performance for timeliness, complete-
ness and accuracy is essential to deter-
mining if they are gathering the infor-
mation needed for financial counseling
and upfront collections.
Next, evaluate your financial coun-
seling. This process informs patients
about how much their insurance com-
pany promised to pay on their behalf
and their personal financial respon-
sibility. Provide this information to
patients at least 3–5 days prior to their
date of surgery. In addition, inform
patients of all payment types offered
by your center and obtain a commit-
ment on how they plan to cover their
responsibility on the date of surgery.
Timeliness and proficiency of your
financial counselor can be measured
by the success of upfront collections
and the number of promissory notes or
payment plans issued.
Collecting the patient's financial
responsibility prior to the procedure is
the final essential process. Its success
largely depends on how well the pre-
vious processes were performed. Prior
to surgery, your financial counselor
Reprinted with permission from the Ambulatory Surgery Center Association.

3. ASC FOCUS MAY 2021 |ascfocus.org 21
BILLING
should provide the registration clerk
with the amount of the patient's finan-
cial responsibility and how the patient
is planning to meet their financial obli-
gation. To measure the upfront collec-
tions success, compare the patient's
commitments to pay, as provided by the
financial counselor, to the upfront col-
lection amounts.
Areas Directly Affecting
Reimbursement (Post-Procedure)
Following the procedure, certain steps
must be completed properly and con-
sistently to help ensure your ASC
obtains appropriate reimbursement.
Accurate coding is the bedrock of
reimbursement. Errors can financially
impact your center and put you at risk
for noncompliance. Submitting claims
with procedure and/or diagnosis codes
not supported by the operative note puts
your center at risk of a compliance audit
and resulting fines and presents the pos-
sibility your center is not obtaining
allowable reimbursement. Coding mis-
takes also often result in claim delays
or denials. Establishing a denial log
listing the reasons for denials will help
pinpoint the number of claims denied or
delayed because of coding errors.Addi-
tionally, check your coder's accuracy
with regular internal audits and annual
audits by an independent third party.
After receipt of coding information,
your charge poster should enter charges
in the proper format and submit claims
via your clearinghouse. Clearinghouse
reports identify errors that require cor-
rection. After making necessary correc-
tions, resubmit claims. Finally, to ascer-
tain the submission of all claims, tally
the number of accepted claims listed
on the clearinghouse receipt against
the number of coded cases listed on the
coder's report.
To determine percentage of clean
claims submitted, compare the total
number of claims submitted to the
number of rejected claims. Also, audit
reasons for rejections and timeliness
of correction/resubmission and com-
pare the number of claims submitted
to the number of scheduled cases for
the specific date.
Proper submission of claims as
described above should result in
timely and accurate reimbursement.
Payment posting should be performed
on the date of payment receipt. Your
payment poster should be familiar
with contract allowances. Better yet,
the specific contract rates should be
entered in your ASC's software, help-
ing ensure that you can recognize the
accuracy of payments and appropriate
adjustment of fees.
Payment posters are responsible for
completing the denial log and disburs-
ing information to the appropriate reve-
nue cycle team member to fix errors and
resubmit corrected claims. The pay-
ment poster also is responsible for ini-
tiating the appeals process when there
is a discrepancy or payment denial. To
measure the proficiency of the payment
posting process, compare daily bank
deposit to your payment posting batch
report, audit the denial log to deter-
mine if it is current and all entries have
been assigned to the appropriate team
member for follow-up and run an aging
report on claims in appeals.
Depending on the carrier's guide-
lines, follow up on electronically sub-
mitted claims should begin as soon as
seven days to a maximum of 21 days.
Collectors can often obtain the status
of specific claims via payer websites,
but some must be contacted directly.
Collection efforts should be noted in
the patient's chart, and information
regarding date of expected payment
should also be entered in a tickler file
to help ensure timely follow up.
Depending on your center's soft-
ware, collectors may be able to access
reports on aged accounts receivable
(AR) by payer to help pinpoint which
accounts should be followed up on
first. To measure collection efforts,
audit appropriate AR reports to assess
age of accounts, timeliness of follow
up, claim denial management and
other important processes.
Following the receipt of full and
accurate reimbursement and any nec-
essary and approved write-offs, trans-
fer the remaining account balance to
patient/guarantor responsibility. Send
patient statements immediately and
then every four weeks until yourASC is
paid. To determine if patient collections
are followed appropriately, run aging
reports of patient balances and appoint
a team member to follow up on them.
Stronger Staff Performance,
Stronger Bottom Line
When your ASC appears to be running
efficiently but cash flow is less than
anticipated, doing a deep dive into all
areas of the revenue cycle will help
determine where revenue leaks are
occurring. Take the time to effectively
assess whether your billing staff is at
peak performance, paying particular
attention to timeliness and accuracy of
revenue cycle tasks. These two param-
eters must be met to ensure a consis-
tent revenue flow and financial success
for your ASC.
Caryl Serbin, RN, is the president and
founder of Serbin Medical Billing in Fort
Myers, Florida. Write her at caryl@
serbinmedicalbilling.com.
Reprinted with permission from the Ambulatory Surgery Center Association.