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Unlocking the Power of RCM: 7 Proven Strategies to Increase Implant Collections and Accelerate Cash Flow for ASCs

Revenue Cycle Management (RCM) is critical to ambulatory service centers (ASCs) and healthcare administrators’ financial success. It involves managing the entire patient journey, from initial appointment scheduling to payment collection, to maximize revenue and cash flow.

Implants are standard in many surgical procedures in the outpatient setting and are notorious for being one of the most expensive components of any surgery. Increasing the implant rate of collections and cash flow is a key financial consideration.

Collecting payment from implant patients at the point of service can help increase cash flow and reduce collection costs by reducing the number of outstanding balances. Monitoring claims to identify potential denials and addressing them proactively to increase cash flow and revenue.

In this blog, we will discuss 7 RCM strategies that can increase the implant rate of collections and cash flow for ambulatory service centers and healthcare administrators.

Streamline Implant Patient Intake Ahead of Time

Most implant claim errors can be traced back to front-end operations and the patient intake process. To improve accuracy, new patients can complete paperwork before an appointment if your practice management software offers an online portal.

This relieves front desk staff from manually transcribing data from paper forms, which reduces human error and allows them to verify information with the patient upon arrival.

Capturing patient demographics ahead of time streamlines your operations and means less time in the waiting room for patients, plus patients can skip the process all together if your EHR (Electronic Health Record) integrates with local hospital systems and other providers.

When the same medical history is shared among all attending healthcare professionals, outdated or inaccurate information decreases, which decreases the likelihood of a claim being denied or rejected due to inaccuracies. Filling out less forms in the office is also more convenient for patients.

Verify implant patient information.

Verifying implant patient information is an important step to ensure accuracy in the billing and claims process.

This can be done by double-checking patient demographics, insurance information, and implant-specific details such as the type of implant, the date of the implantation, and the name of the implanting surgeon.

By verifying insurance and the patient’s fiscal responsibility before a procedure, you can educate the patient on the estimated cost of any out-of-pocket expenses that may be incurred.

Front desk staff or billing personnel can verify this information with the patient upon arrival, or by following up with the patient before their appointment if necessary.

Obtain timely and accurate prior authorization to increase clean claims.

According to a recent AMA survey, 88% of physicians find the administrative burden associated with prior authorization high and consider the turnaround time associated with prior authorizations a major hurdle for patients requiring immediate care for medical procedures.¹

Automation can reduce the time and paperwork involved in the prior authorization process, which also improves the accuracy of the claim submission process and reduces the chances of errors or delays due to lost or misplaced documents.

Streamline transcription, coding, and billing.

Streamlining transcription, coding, and billing processes can help improve efficiency and accuracy in the implant billing and claims process.

Understanding how payers code will ensure the claim submission is aligned with coding requirements. There are specific codes for implant procedures that indicate the type of implant, the location of the implant, and the reason for the implant.

Ensuring accurate implant and invoice capture is essential to improve the coding process. Implementing a robust system that accurately records and tracks the implant details and the corresponding invoices can increase cash flow. Using the wrong code or failing to code the procedure correctly can result in denied claims and lost revenue.

A medical necessity review should be conducted to ensure that the implant is justified and necessary for the patient’s treatment. A reconciliation process should match the implants and invoices against the patient’s medical records, ensuring the accuracy of the claim submission.

Analyze any patterns or trends that can be resolved to improve clean claim rates.

Analyzing claim denials can help identify and resolve the most common errors related to implant patients in ambulatory surgery centers (ASCs).

To analyze claim denials, ASCs and healthcare administrators can use data analytics tools to review and analyze their claims data. They can also leverage revenue cycle management (RCM) software to track claims and monitor the status of claims throughout the billing process.

Regularly review high dollar claim management process to identify common reasons for claim delays and denials. Auditing the reasons for claim issues will help you notice patterns with a particular implant or payer.

Establish a high-dollar claims work queue for your A/R follow up team.

Establishing a high-dollar claims work queue for your accounts receivable (A/R) follow-up team can help prioritize and streamline the process of following up on outstanding implant claims.

The longer a claim lingers in A/R, the longer it will take to receive reimbursement. Therefore, training staff to identify claims with a higher reimbursement value and prioritize them accordingly is critical to the accounts receivable follow-up process.

Implementing a high-dollar claims work queue will help staff prioritize claims based on factors such as the dollar amount, the age of the claim, and the payer involved.

Establishing clear communication channels with payers and tracking all communication related to high-dollar claims is also important. Your team can leverage technology to streamline the follow-up process and automate tasks like sending follow-up emails or reminders.

If a claim is denied or delayed, your A/R team should be prepared to appeal the decision and follow up appropriately. This may involve providing additional documentation or further communicating with the payer.

Analyze claim denials to resolve implant patient errors.

Analyzing claim denials can help identify and resolve the most common errors related to implant patients in ambulatory surgery centers (ASCs).

To analyze claim denials, ASCs and healthcare administrators can use data analytics tools to review and analyze their claims data. They can also leverage revenue cycle management (RCM) software to track claims and monitor the status of claims throughout the billing process.

Regularly review high dollar claim management process to identify common reasons for claim delays and denials. Auditing the reasons for claim issues will help you notice patterns with a particular implant or payer.

By taking a proactive approach to addressing common errors related to implant patients in ASCs, healthcare organizations can improve revenue cycle management, increase collections, and improve overall financial performance.

Summary

By implementing these strategies, ASCs and administrators can improve their implant collection processes, increase revenue, and reduce the risk of errors and denials.

As your staff becomes more knowledgeable with your payer contract terms, you’ll have fewer errors and less issues with implant claims.

We highly recommend implementing automated systems and tools. By investing in the necessary resources and training, ambulatory surgery centers can increase their clean claim rates and reduce the burden of denied claims on staff and patients.

The following webinar discusses the overlooked revenue cycle management (RCM) processes that ambulatory surgery centers need to review before the end of the year to ensure financial success.

In it, Scott Allen, Vice President of Managed Care Contracting, highlights the importance of updating fee schedules, analyzing denied claims, tracking patient balances, and reviewing payer contracts.

Scott Allen is a seasoned professional in managed care contracting with a deep understanding of the complex healthcare landscape; skilled in developing strategies to optimize reimbursement rates, improving payer relationships, and ensuring compliance with regulatory requirements.

Are you looking for ways to improve your revenue cycle management? Take the first step towards optimizing your revenue cycle process by requesting a revenue assessment from our team of RCM experts. Request a demo.

References:

  1. American Medical Association. (2018). AMA Prior Authorization (PA) Physician Survey. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
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