19 Aug How Ambulatory Surgery Center Billing Affects Your Profits
The claims that are submitted to insurance companies by ambulatory surgery centers (ASCs) are the major source of income for most ambulatory surgery centers. Less than 10% of patients pay out-of-pocket for the services they receive leaving the cash flow to come from government supported programs like Medicare and Medicaid and private insurance companies. As requirements to meet specifics grow into greater responsibility to complete billing precisely, many ASCs are opting to hire an outside company to handle their ambulatory surgery center billing for them with the goal of improving their bottom line.
Potential for Claim Denial
Nearly every patient that visits the ASC will require an insurance claim to be submitted. Due to the nature of the business, Patients are only at the center for a matter of hours during a single day. That means the number of claims filed for any day is nearly equivalent to the number of patients seen. This is a large volume of claims that have a deadline by which time they are required to be submitted.
For claims that are made to Medicare and to Medicaid, specific codes are used to specify the specific procedure that was provided. When the code is entered incorrectly, the claim may be denied. Often, this can happen within a long enough time frames that the deadline approaches before the form is corrected and resubmitted. When the claim is denied, the ASC does not get payment for that procedure. The only way for the clinic to get the maximum profits from their business is to get the majority of their claims paid.
Making an Ambulatory Center Financially Successful
No medical professional opens a clinic with the hopes of just getting by or failing. Creating a successful practice requires the optimal performance of their clinical processes as well as those related to their billing and accounts payable. Ambulatory surgery center billing requires training, dedication, and the proficiency at preparing claims that will result in a fast turnaround.
When the ASC takes care of billing in-house, they must begin by verifying the insurance coverage for each patient and verify all of the information that applies to the patient and the reason for their business. Co-pays and co-insurance must be collected at the time of the visit to reduce the amount of payments for which billing and collections will apply.
All of the information that applies to the patient should be verified upon admissions. This will help to prevent errors that could result in claims being delayed and/or denied. Depending on the extent that the ambulatory surgery center billing services manages the billing process, the next step is often for the billing company to provide expert coding to complete the claim for submission.
Speed up Claims Processing with Electronic Processing
The software available from an ambulatory surgery center billing service can be integrated to work with your electronics records for faster, more efficient processing of insurance claims. Working together with the billing company will help streamline the process according to the ASC’s policies and result in an improved cash flow and the overall profits of the business.