Reimbursement is a Team Effort
By Caryl Serbin, RN, BSN, LHRM
Generally, we think that our ASCs' coders, billers and collectors are solely responsible for collecting the fees owed. However, securing full reimbursement requires the efforts of the entire team working together.
Schedulers — Request accurate and up-to-date patient demographics and insurance information so that claims are not denied or delayed due to incorrect or insufficient details.
Insurance Verification Specialist — Verify insurance coverage (not just computer-generated eligibility information) by requesting pre-authorization number, eligibility or benefits information, in- and out-of-network information (OON) for OON claims, patient responsibility for copays/deductibles, reference call number and payor electronic payor number or claim address. Use computer-generated or paper insurance verification form so nothing is forgotten.
Patient Financial Counselor — Call the patient at least three days prior to the procedure and explain their financial responsibility. Provide options for payment and obtain commitment from the patient as to amount and method of payment. Advise admitting desk of the patient's financial responsibility.
Receptionist — Collect agreed-upon payment amount from the patient at the time of registration. Verify insurance for accuracy; copy/scan both sides of the insurance card.
Medical Records Specialist — Provide the coder with a copy of the operative note in a timely manner. Also provide the coder with pathology and other related reports for accurate and optimal coding.
Management — Plan ahead and provide advance notification to the patient about the ASC's financial practices (via brochure, website, flyer), perhaps as part of the physician's office handouts.
Even with everyone doing their part, getting reimbursed correctly and in a timely manner is becoming more challenging. Teamwork is the best chance your ASC has to collect what it is owed.