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Billing Operations for Your ASC
By Caryl Serbin, Surgery Consultants of America
When evaluating deviations in revenue in a surgery center, we tend to look at coding,
billing and collections to determine the cause. However, there are numerous factors
influencing the billing operations, many of which do not fall under the responsibility of
your coding, billing and reimbursement specialists. Reimbursement is affected by the
competency of your front-end processes of scheduling, verification, and registration.
Indirect issues such as your fee schedule, how your office handles out-of-network
issues, your managed care contracts, and the technology being used in your surgery
center also have an impact on billing operations and likewise reimbursement.
Many factors which affect the timely collection of revenue take place prior to the day
of surgery. As you can see below, the front-end process is one of the most important
parts of your billing operations.
Request as much information from the physician’s office as they are comfortable in
providing, including pre-authorization codes, if applicable. Contact the patient if
additional information is needed. Input all demographic and insurance information
accurately. Transposing just one number can delay your claim indefinitely.
Verify eligibility and benefits and obtain a pre-authorization code if necessary. Verify
claim address. Note any special instructions for the billing specialist.
Patient Financial Counseling
Notify the patient regarding copayment or deductible due on the day of surgery. If
necessary, payment plan arrangements can also be discussed at this time.
On the date of surgery, confirm all demographic and insurance information with the
patient. Copy their insurance card, verifying the patient identification and group
numbers and claim address with what is in the computer.