Fundamental Best Practices for Successful ASC Collections
By Caryl Serbin, RN, BSN, LHRM
There is no single magic rule for successful ASC collections. To obtain accurate and timely reimbursement, your ASC needs the following:
Experienced ASC collectors
Understanding and enforcement of contract language
Enforcement of state prompt-payment regulations
Excellent time-management skills
Obtaining definite date of payment
Use of tickler file for regular follow-ups
Appropriate ratio of collectors to accounts (combined third-party payer and self-pay). We suggest one collector to 850- 900 accounts.
Here are five of the best practices we consider fundamental to collections success:
1. Confirm claim received by payer within 5-7 days of submission. If possible, perform verification electronically.
2. Follow up on unpaid claims at least every 30 days. Use payer-specific or generic websites, where possible.
3. Denials should be responded to immediately with a well-written appeal letter that addresses the reason for the denial and contains requested information/corrections.
4. Follow appeals to the highest level of adjudication.
5. Run accounts receivable reports on a regular basis to measure payer trends, collector trends and collection goal achievement. Share and discuss the results with collectors.