Attacking your aging is essential to ambulatory surgery center revenue cycle management (RCM) success. Reducing your surgery center’s A.R. begins long before you submit any claims. The key to setting up your revenue cycle for success is to eliminate gaps in your front-end processes, preventing errors and delays that could lead to significant financial losses. Tackling your aging accounts while efficiently moving claims through the revenue cycle is a demanding task for any billing team—this is where technology becomes invaluable.
The Ripple Effects of Pre-Service Inefficiencies
High denial rates and increasing A.R. days often stem from deeper issues within the revenue cycle. Instead of resorting to temporary solutions, it’s important to identify the root causes of these challenges. The key lies at the very start of the revenue cycle. Contrary to common belief, these early processes are critically important to your bottom line. Addressing your aging should begin when your revenue cycle does: before the date of service.
An RCM analysis found that most denials originate from front-end RCM processes. Over 12% of denials are due to errors in authorization or precertification, and nearly 24% result from registration and eligibility mistakes.1 The connection between initial billing tasks and revenue loss is evident. Fortunately, there are concrete steps your team can take to resolve these issues and move your revenue cycle in the right direction.
Three Steps to Optimize Front-End RCM
Start by thoroughly reviewing your RCM processes with your team, identifying underlying issues, and planning for improved accuracy and efficiency. Here’s a step-by-step approach:
- Align your workflows. Review all front-end financial clearance processes for gaps. This includes capturing benefits information, obtaining prior authorizations, accurately documenting demographic information, verifying insurance, obtaining benefit information, and obtaining pre-service collection. Addressing errors early prevents downstream disruptions.
- Stay on top of prior authorizations. Always verify whether a patient requires prior authorization before the date of service. Without it, your claim faces immediate denial. Triple-check the need for authorization and keep it readily accessible for insurance carriers.
- Educate patients early about financial responsibility. Avoid surprising patients with bills on or after their surgery. Clearly explain their financial obligations beforehand. The likelihood of collecting payment drops from 70% before or on the date of service to 30% after they leave.2 Setting up a payment plan upfront can significantly improve your collection rates.
Leveraging Technology for Profit
Incorporating technology into front-end RCM processes is essential to eliminate errors, reduce denials, and improve efficiency. Automation streamlines eligibility verification and provides real-time data visibility for accurate insurance and demographic information.
Start with automating these processes:
- Eligibility pre-claim submission
- Procedure and diagnosis validation
- Member ID check and demographics
- Patient estimator via text message
- Payment plan set up
With the right technology solutions, your ASC can achieve greater efficiency and a steady decrease in A.R. That’s why you shouldn’t miss in2itive’s Jocelyn Gaddie at ASCA 2024, where she will share valuable insights on technological innovations to reduce aging accounts on April 18 at 8 AM.
Looking for an expert RCM partner to enhance your facility’s revenue? Explore tech-driven strategies tailored to your ASC’s needs with in2itive to help you overcome inefficiencies and boost long-term profitability.
Sources
- Meyer, S. (2018, December 19). 4 keys to driving down denials. Medical Group Management Association. https://www.mgma.com/articles/4-keys-to-driving-down-denials
- Williams, K. (2018, July 12). Address Patient Financial Risk in Pre-Service to Boost Revenue and Earn Loyalty. Healthcare Financial Management Association. https://www.hfma.org/revenue-cycle/financial-counseling/61208/
