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endoscopy center management Archives - Pinnacle III

Sep 28
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When a Screening Colonoscopy Becomes Diagnostic: Educating Patients on Financial Responsibility

When a Screening Colonoscopy Becomes Diagnostic: Educating Patients on Financial Responsibility

By ASC Management, Uncategorized No Comments

A patient comes into your ASC and undergoes a screening colonoscopy. Polyps are found during the procedure and are removed. Considering the circumstances, this sounds like good news. The screening served its purpose. You detected and removed cancer precursor lesions, hopefully helping to prevent the disease.

There’s just one problem: The patient is angry. Not about the successful removal of the polyps, but about how a change in type of procedure also changed the patient’s financial responsibility. A scheduled screening colonoscopy has become a diagnostic colonoscopy. Rather than being a preventative service provided at no cost to the patient after their insurance has processed the claim, the patient now owes a payment – possibly one considered quite significant.

Guidance for Screening Colonoscopy Education

By taking a proactive approach to colonoscopy education, your ASC can help reduce its number of upset patients. You may even improve their satisfaction in the process. Here are some recommendations on how to help patients understand their potential financial responsibilities before undergoing a colonoscopy.

Develop Documentation

Alleviate some of the confusion about colonoscopies by providing patients with documentation explaining possible outcomes of their screening colonoscopy. Share background on preventative services, noting limitations on this provision. Explain how the definition of a preventative service is adjusted due to changing (and strict) insurance guidelines. Elaborate on how this may affect patients scheduled for a screening colonoscopy and their financial responsibility. Define the categories of colonoscopies: screening/preventative, diagnostic/therapeutic, and surveillance/high-risk.

This background information will hopefully help patients gain a better understanding of colonoscopies. Then summarize what can happen when patients receive a screening colonoscopy referral. Describe how categorization can change based on information captured during the scheduling and pre-procedure processes. Consider addressing some frequently asked questions, such as whether physicians can change a diagnosis so a procedure can qualify as screening and why insurance companies may seem to indicate that your ASC can alter a CPT or diagnosis code.

Share Benefits Information

Along with this documentation, provide patients with information about their colonoscopy benefits. Give your benefits coordinator a form to fill out when they review coverage information online and/or contact patients’ insurance carriers. This form would include details on patients’ covered benefits concerning screening and diagnostic colonoscopies. It would also state patients’ financial responsibilities (or potential responsibilities), broken down by co-pay and deductible.

You may want to include details about payment plans your ASC offers on this form. This can help patients start planning how they will pay for their care if the colonoscopy categorization changes. Include this form with the background documentation.

Speak Directly With Patients

While these documents should better prepare patients for their colonoscopy and possible financial outcomes, calls to patients are also worthwhile. Use this opportunity to review the information in the documentation and form. Ensure individuals at your ASC who speak with patients can explain the difference between screening and diagnostic colonoscopies. Staff should receive training to help them effectively communicate with patients and accurately answer questions.

Quick Tips for Dealing With Upset Patients

Despite your best educational efforts, you may still receive phone calls from upset patients following their colonoscopy. Consider following these steps to help address their concerns:

  • Let them vent. If patients sound animated, give them time to share their thoughts and feelings. Avoid interrupting and try to respond only when asked a question. Giving patients this opportunity to vent can help them calm down and become more focused on the discussion to follow.
  • Remain polite. Throughout your conversation, strive to remain polite, listen carefully and remain calm. If patients believe you are becoming frustrated, not listening closely, or failing to take their concerns seriously, they are likely to become angry.
  • Review case history. Help patients feel like you take their concerns seriously by discussing the details of their situation. Pull up their chart and bill. Talk through the procedure: what was scheduled and found, and how that affected information submitted to their insurance carrier. Verify that your ASC properly coded and billed the procedure.
  • Explain insurance rules. After discussing the case history, patients may still question what they owe. Describe health insurance rules and how they dictate changes in colonoscopy categorization. Provide education on diagnosis codes and your ASC’s requirements to code based on the procedures performed, not scheduled. Discuss the claims submission process and how that triggers the health insurance reimbursement process. Note: If patients spoke with their insurance before you, they may have been told that had you coded the procedure as a screening colonoscopy, it would have been covered. Be prepared to explain the potential fraud implications of improper coding and billing.

Going through these steps can provide comfort to patients and help them better appreciate your ASC’s responsibilities. Once you address any outstanding questions, move to the discussion about how patients will cover what they owe. Be cognizant that patients may be in a delicate state as they come to accept their financial responsibility. Help relieve some stress by informing them of payment options that can spread their financial responsibility over time. While patients may express displeasure with what they’re hearing, patience and compassion can move the situation toward a positive resolution.

Catherine Sayers, Director of Operations

Jun 19
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Running a Successful Endoscopy Center is all about Patient Access

Running a Successful Endoscopy Center is all about Patient Access

By ASC Management No Comments

In ASCs, where surgical procedures are performed, volume is typically driven by surgeons. ASC leadership is responsible for making it easy for physicians/surgeons to bring their procedures to the facility.

Most adults need to undergo a routine colonoscopy when they turn 50. In an endoscopy center, the volume is driven by patients or their referring primary care physicians (PCPs). Therefore, an endoscopy center’s leadership must make it easy for patients to come to the center for their procedures. Without ease of access, patients are likely to look elsewhere for care and PCPs are likely to refer elsewhere.

Eight steps endoscopy centers can take to improve patient access and grow their volume in the process follow.

1. Be easy to find.

Make sure patients and PCPs can find your center without much effort. These days, that means developing and maintaining a strong internet presence. Keep your website current. Make sure it’s mobile friendly by incorporating a responsive design. When patients search for a place to receive a colonoscopy, you want your center showing up on the first page of results and as close to the top of that page as possible.

2. Provide direct access.

Give patients the ability to call and schedule their procedure directly with you. Make this as simple a process as possible – you don’t want to give patients a reason to hang up.

3. Conduct community outreach.

The internet is a valuable tool to connect with patients but don’t underestimate the power of human contact. Participate in outreach programs. Encourage your physicians to give talks at community centers. Attend senior expos and other events that are likely to attract your target demographics.

4. Streamline the referral process.

Provide local PCPs with packets of information about your endoscopy center and colonoscopy scheduling process. These packets should include everything a patient needs – health history form, consent form, preparatory instructions, directions to your facility, contact information, etc. PCPs will appreciate your efforts to help their patients receive care. This is an effective way to directly market to patients and PCPs.

5. Network with PCPs.

Focus on building strong relationships with PCPs and their offices to encourage referrals. Schedule lunch meetings where you can talk about your center and the services you offer. Discuss any barriers to access and what you can do to help remove them. Whenever possible, involve your physicians in these efforts which will help develop peer-to-peer connections with PCPs.

6. Analyze referral patterns.

Keep a close watch on your referring physicians’ case volumes. If you witness a noticeable decline, determine the cause and try to fix it. If volume is flat, find out if there is anything else you can do to encourage more referrals. When volume increases, express appreciation and make sure you maintain a high quality of service.

7. Monitor physician activity.

Make sure you are on top of the movement of physicians in your market, especially those who are high referral sources. When a referring physician changes practices, make sure the new practice receives your patient packets. Schedule time to meet with this physician to reestablish your connection, if necessary. You can also use this as an opportunity to speak with this physician’s new partners about becoming referral sources. If a new PCP comes into the market, be the first one to welcome him or her. Reach out and schedule a meeting. A positive first impression can go a long way toward securing referrals.

8. Stay current.

Be on the lookout for new gastroenterology and endoscopy procedures and technology. For example, new means for treating fecal incontinence are gaining greater acceptance. As word spreads about such advancements, you may want to offer these services. Doing so can add case volume while elevating your center’s profile, bringing attention to the other services your endoscopy center provides. Keep an open mind to what you can do in your center. Developments coming down the pipeline may be worth considering.

Remain Proactive

There’s a lot of competition for patients and referrals. To maintain ease of patient access and remain a primary referral destination, vigilance is required. Establish processes for monitoring your internet presence. Ensure continuous communication with your referral sources. Do whatever is necessary to establish your endoscopy center as the provider of choice for patients and PCPs – then don’t let up! The moment you take your ease of patient access and referral sources for granted, another facility may seize the opening.

Catherine Sayers – Director of Operations