Collections Issues for ASCs

If there are complicated financial arrangements to be made or the patient or responsible party becomes disruptive during financial discussions taking place in the ASC’s lobby, move the discussion to a quiet place, so as to disturb other patients/families.

Copy the front and back of all patient insurance cards and a copy of the patient’s (or responsible party, if different) driver’s license. Be sure the ASC’s registration documents prompt a correct and current address and home/work telephone numbers for the patient and/or responsible party. Be sure to update and correct this information each time the patient has a case at the ASC and don’t assume the information hasn’t changed.

For plastics cases, it is extremely important to collect in full for the procedure prior to the case being performed. Since these are cash-basis procedures, these patients should not be allowed to string out their payments over a long period of time. If you allow payment plans for these patients, only allow two to four payments, and try to collect at least one-half of the total charge prior to the surgery.

If your facility is not participating with a payor (non-par), there is a possibility the payor might issue the ASC’s check to the insured, instead of to the ASC directly. Be very clear with the patient in these circumstances that he/she may be receiving the insurance check and that he/she must notify the ASC as soon as payment is received and immediately endorse the insurance check over to the ASC or write a personal check for the full amount upon receipt. The patient should sign a promissory note before the surgery ensuring the payment will be made to the ASC.

Timely Filing of Claims

It is very important to be familiar with your facility’s payor contracts regarding their requirements for the timely filing of claims. HMOs typically have tighter timelines for timely filing than do other payor types. Have good procedures in place at your facility for capturing charges and necessary claim information on cases to file claims within the required timelines.

Collections Problems with Insurance Companies

It is very important to follow-up with payors on claim status consistently and at regular intervals. ASC staff should contact the payor by telephone, electronic systems or via the internet to check claim status.

If the payor is “giving you the run around,” you can try to get the patient/insured involved. Let them know the payor is not processing the ASC’s claim. You might want to consider informing the patient that he/she might be billed for the balance (unless it is a violation of your contract with the payor). The patient/insured can be very helpful in these problematic circumstances. If you continue to have problems being reimbursed by a particular payor, contact your provider relations representative or speak with the head of the claims department to assist with claim resolutions.

Check your payor contracts and know the laws in your state for the length of time the payor has for processing “clean claims.” If the payor continually misses that claim processing deadline (which is frequently 30 to 45 days from the date the claim was received), do not hesitate to write a letter to your state’s insurance commissioner as a formal complaint. Forward a copy of that letter to the offending payor at the same time — you should receive a claim determination (hopefully, a check) shortly. Reporting a payor to the insurance commissioner amounts to pulling out “the big guns” — so consider this to be a last resort.