Here are five ways pain management centers can improve collections.
1. Make sure all of your payor contracts are loaded into your billing and collection software. If your billing and collections software allows it, make sure all of your contracts are uploaded, says Michael Orseno, revenue cycle director for Regent Surgical Health. This will feed into other areas such as electronic remittance advice (ERA) — an electronic version of a payment explanation — and contractual variance reports. Some payors change their rates at the beginning of the year, so ensure all of your existing contracts are up to date.
"If you have your contracts loaded into the system, it makes management's job exponentially easier because you will be able to run reports to determine how much you were paid versus how much you were supposed to be paid for different procedure codes," Mr. Orseno says. "Then you can identify where you're being underpaid or if you're not charging enough for a particular procedure."
2. Drop the payor if they have unilateral changes in product participation. Sometimes ASCs unwittingly agree to unilateral changes in product participation. For example, the insurer may add the center to its workers' compensation, Medicare or Medicaid products at lower reimbursement rates, such as 90 percent of the state allowable. "This allows the payor to make a little money at the ASC's expense," says Tammy Brinkman, director of contracting and reimbursement at Blue Chip Surgical Center Partners in Cincinnati.
The payor initiates this strategy by sending a letter announcing the policy change, in the hope that it will be opened by a staffer who simply files it away. After all, the letter states: "No action is needed on your part." What this really means is if no action is taken, the ASC is stuck participating in these products with undesirable rates for the remaining term of the contract. However, the company provides a window, typically 90 days long, to refuse this unilateral change. If someone at the center carefully reads the letter within that time period, it can reject the offer and avert low payments without having to end the contract.
3. Discuss all costs with the payor during contract negotiations. While the payor may initially be interested in the cost of hardware or other material costs associated with a procedure, you can also share additional surgery center expenses to paint a broader picture of the financial situation. "Bring in the cost of compliance," says Jim Odom of The C/N Group. This tactic is especially important considering compliance can cost a center upwards of $20,000 per year. Supply costs and labor costs are also increasing, which places a burden on the company.
"If the payor is the provider for the health insurance plan for your employees, remind them of their rate hikes," says Tom Faith of The C/N Group.
4. Train staff in patient collections. Pain management physicians must have a staff trained in the best methods for collecting from your patients. The scheduler should know whether patients have an outstanding balance when they call for a follow-up visit, and if they do, ask them to send the payment in prior to the visit. "The front desk staff needs to be trained in collection procedures because most people naturally aren't very comfortable asking for money," says Bill Gilbert of AdvantEdge Healthcare Solutions. "Have a script written up for the front desk staff so that when they ask for patient payments, they begin with the assumption that patients are going to pay." This might mean asking the patient which type of credit card they'd like to pay with instead of asking how they would like to pay.
5. Lower staff turnover. Finally, ASCs should recruit an experienced and talented administrator and strong clinical lead to empower staff and ensure appropriate coverage for case volume. A best practice in this area also involves providing incentives for productivity and patient satisfaction to all levels of staff. "Staff has to know you have their back. You can't run a great organization if you have high turnover," says Robin Fowler, MD, founder of Interventional Management Services.
Related Articles on Pain Management:
12 Statistics on ASC Pain Management Case Volume
6 Points on Treating Post-Traumatic Stress Disorder With Stellate Ganglion Block
Back Pain Program at Greenville Hospital System Aims to Streamline Care
"If you have your contracts loaded into the system, it makes management's job exponentially easier because you will be able to run reports to determine how much you were paid versus how much you were supposed to be paid for different procedure codes," Mr. Orseno says. "Then you can identify where you're being underpaid or if you're not charging enough for a particular procedure."
2. Drop the payor if they have unilateral changes in product participation. Sometimes ASCs unwittingly agree to unilateral changes in product participation. For example, the insurer may add the center to its workers' compensation, Medicare or Medicaid products at lower reimbursement rates, such as 90 percent of the state allowable. "This allows the payor to make a little money at the ASC's expense," says Tammy Brinkman, director of contracting and reimbursement at Blue Chip Surgical Center Partners in Cincinnati.
The payor initiates this strategy by sending a letter announcing the policy change, in the hope that it will be opened by a staffer who simply files it away. After all, the letter states: "No action is needed on your part." What this really means is if no action is taken, the ASC is stuck participating in these products with undesirable rates for the remaining term of the contract. However, the company provides a window, typically 90 days long, to refuse this unilateral change. If someone at the center carefully reads the letter within that time period, it can reject the offer and avert low payments without having to end the contract.
3. Discuss all costs with the payor during contract negotiations. While the payor may initially be interested in the cost of hardware or other material costs associated with a procedure, you can also share additional surgery center expenses to paint a broader picture of the financial situation. "Bring in the cost of compliance," says Jim Odom of The C/N Group. This tactic is especially important considering compliance can cost a center upwards of $20,000 per year. Supply costs and labor costs are also increasing, which places a burden on the company.
"If the payor is the provider for the health insurance plan for your employees, remind them of their rate hikes," says Tom Faith of The C/N Group.
4. Train staff in patient collections. Pain management physicians must have a staff trained in the best methods for collecting from your patients. The scheduler should know whether patients have an outstanding balance when they call for a follow-up visit, and if they do, ask them to send the payment in prior to the visit. "The front desk staff needs to be trained in collection procedures because most people naturally aren't very comfortable asking for money," says Bill Gilbert of AdvantEdge Healthcare Solutions. "Have a script written up for the front desk staff so that when they ask for patient payments, they begin with the assumption that patients are going to pay." This might mean asking the patient which type of credit card they'd like to pay with instead of asking how they would like to pay.
5. Lower staff turnover. Finally, ASCs should recruit an experienced and talented administrator and strong clinical lead to empower staff and ensure appropriate coverage for case volume. A best practice in this area also involves providing incentives for productivity and patient satisfaction to all levels of staff. "Staff has to know you have their back. You can't run a great organization if you have high turnover," says Robin Fowler, MD, founder of Interventional Management Services.
Related Articles on Pain Management:
12 Statistics on ASC Pain Management Case Volume
6 Points on Treating Post-Traumatic Stress Disorder With Stellate Ganglion Block
Back Pain Program at Greenville Hospital System Aims to Streamline Care