Revenue Cycle Management

insurance claim

An Insurance Claim is Like Baking a Cake – Here’s the Perfect Recipe

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I enjoy cooking and baking. Spending time in the kitchen is my happy place. And I’ve been involved in revenue cycle management for many years. But I bet you’re wondering what baking and insurance claims have in common. Please allow me to explain.

Certain ingredients are required to bake a cake. When you follow a recipe, paying attention to every detail along the way, you’re likely to get it right. Voila! You end up with the perfect dessert.

Submitting a clean claim is no different. Taking the right steps (ingredients) and following the right process (recipe) will result in a clean claim (cake). A clean claim increases the chance of being paid correctly in a timely manner (icing).

Here’s a clean claim recipe:

  • Ingredient #1: Demographic information
    • Schedule patient.
    • Register patient and insurance demographic information into patient accounting system.
    • Verify patient’s benefits and eligibility with the payor.
    • Submit prior authorization request, if required.
    • Prepare estimate of payor and patient responsibility for services being rendered.
    • Discuss estimate with patient.
    • Collect copay and/or outstanding deductible from patient prior to service.
  • Ingredient #2: Charge capture and coding
    • Assign ICD-10/CPT codes from the operative note.
    • Enter charges into the patient accounting system.
    • Review and address EDI claims edits and rejections.
  • Ingredient #3: Claims submission
    • Follow payor guidelines for paper or electronic claims submission.
    • Verify receipt of the claim by the payor.
    • Manage denials received.
  • Ingredient #4: Claims adjudication and collections
    • Post payor reimbursement timely.
      • Transfer responsibility to secondary payor or patient.
      • Forward underpaid or incorrectly paid claim to accounts receivable for appeal and resolution.
    • Transmit statement to patient.
    • Utilize outside collection agency when necessary (not the icing on the cake).

According to Revenue Cycle Intelligence, research from the Government Accountability Office found up to one-quarter of claims are denied.1 Denials can cripple the financial health of your facility. When providers do not follow payor reimbursement guidelines, payors hold claims for review. If the outlined process isn’t strictly adhered to, payors respond with payment denials. That’s like putting a cake in the oven and not being able to finish it for two or three months.

A strong denial management strategy is essential. It allows you to identify denial trends. When trends are identified, it is important to provide additional education to scheduling and registration personnel to address missed steps and minimize repeat mistakes. The result is an enhanced ability to fully capture the revenue that is due to you. Each step is integral to the success of the claim. Taking shortcuts is ill-advised. You end up with a less than optimal outcome.

Accuracy is key. The process doesn’t work if you skip a step or proceed with inaccurate information. It’s akin to forgetting to add baking powder to your cake. You end up with a “hockey puck” that didn’t rise because of the missing ingredient. Ensuring you have a tight claims process will deliver the delicious outcome you desire – hard earned revenue in the bank. Now that is the real icing on the cake!

Carol Ciluffo – Vice President of Revenue Cycle Management

1Revenue Cycle Intelligence article March 10, 2017 Top 4 Claims Denial Management Challenges Impacting Revenue

ASC scheduling efficiencies

How ASC Scheduling Efficiencies Impact Your Facility’s Revenue

By | ASC Management, Leadership, Revenue Cycle Management | No Comments

Efficiencies in scheduling can be crucial to positively impacting revenue at your ambulatory surgery center.  Maximizing scheduling efficiency creates room for more procedures.  Even if you gain only one or two procedures each day, these marginal gains can easily increase your bottom line.  Therefore, taking steps to cultivate efficiency is an essential strategic initiative. 

Here are seven ways to create efficiency in your ASC’s scheduling process.

1.  Encourage your physicians’ offices to schedule cases as far in advance as possible.  Cases scheduled well in advance of surgery dates allow surgery           center personnel adequate time to prepare for patients.  Obtaining pre-authorizations from some insurance companies can take several days to complete.  Surgery center staff must call patients in advance of their procedure to review their medical history and discuss financial obligations.  Managers staff the center based on the number and types of cases on the schedule.  At times, center personnel need to pre-order special equipment, medical supplies, or patient-specific implants.  If your physicians’ offices encounter changes in their surgeons’ schedules – cancellations, add-ons, time changes, or order changes, for example – encourage them to communicate those changes to you as quickly as possible.  Discuss ahead of time the preferred form of communication for your center – phone, email, fax – to create efficiencies for their team and yours.

2. Establish a strong working relationship with your physicians’ offices to obtain accurate information. Coordinating patient care requires teamwork.  When your ASC serves as an extension of each physician’s practice, the care continuum is virtually seamless.  It is crucial to obtain scheduling forms from your physicians’ offices with comprehensive patient information and up-to-date copies of both sides of the patients’ insurance cards.  This information assists in determining if patients are viable candidates for surgery at your facility from both a clinical and third-party payor coverage standpoint.  If the surgery or procedure falls under workers’ compensation, ask your physicians’ offices to include adjustors’ names and phone numbers.

3. Schedule patients with special needs and your more extensive/high acuity cases at the beginning of the day. Include small children and patients with chronic illnesses, such as diabetes and sleep apnea, in this classification. Scheduling these cases first allows lengthier recovery times to be more easily accommodated.  Additionally, caring for these patients during usual working hours prevents staff from having to stay late or accumulate costly overtime hours.

4. Schedule specialties in the same room whenever possible. This prevents staff from spending valuable time moving equipment from room to room, leading to shorter turnover times. 

5. Schedule similar surgical sites consecutively (i.e., right vs. left, shoulder vs. knee). As an example, for orthopaedic arthroscopy cases, you may prefer to keep all the shoulder cases in line and then move to knee arthroscopies.   This will reduce the need to change positioning devices and room set up between cases.   Speeding up room turnover, anesthesia set up, and the overall flow of surgery, typically yields happier surgeons!  

6. Know what you have to work with. Larger facilities may have the ability to set up rooms by specialty.  Smaller facilities will need to focus on how to best move and position equipment. Train your staff to think strategically about these types of things based on your center’s unique characteristics.

7. Communicate your ASC’s patient criteria to your surgeons and their staff. Patient safety is a priority.  When your physicians and their office staff understand the contraindications and anesthesia requirements at your center, they can schedule their patients at the appropriate facility.   

After you determine the best efficiency workflow processes for booking procedures at your facility, educate physicians, their scheduling staff, and your facility personnel on how they work and why they are set up that way.  Scheduling efficiencies go a long way toward creating higher satisfaction for your team and physicians.  More importantly, scheduling efficiencies create opportunities to add more cases and increase your ASC’s revenue.

Kelli McMahan – VP of Operations

Claims Issue Log

The Claims Issue Log – Not Just Another Spreadsheet

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Claims issues arise daily in the health care billing and collections arena.  If your accounts receivable personnel are repeatedly relaying the same issue, refrain from merely commiserating and determine the scope of the problem.  Is that recurrent theme of inaccurate payments, for example, affecting two or twenty claims?

I’ve found the most effective way to identify trends is to create a claims issue log.

I know what you’re thinking – “I don’t have time for another spreadsheet.”  When used effectively, this spreadsheet can create efficient communication with your payor.  Ultimately, it can lead to timely resolution of issues and correct payment of claims.

What is a claims issue log? 

A claims issues log is a tool that identifies specific details of claims impacted by the same issue with a given payor.  Items on the log may include, but are not limited to:

  • Patient account number
  • Patient and/or subscriber ID
  • Claim number
  • Date of service
  • Network/Plan
  • Total billed
  • Reimbursement due
  • Amount paid
  • Balance due
  • Date billed
  • Billing comments
  • Payor comments

So, you have all this data – now what? 

  • Review your data for accuracy. The first, and most crucial step is to confirm the accuracy of your data.  Another pair of eyes, perhaps those of a manager, is essential at this point.
  • Once you confirm the accuracy of the data, notify your contracting department.  Alert them to the issue.
  • Forward the claims issue log to your provider representative with a clear explanation of the issue. Set expectations.  Outline what steps are required to resolve the problem.  Underscore payment of the balance due must occur as well.
  • Set meetings with all involved parties to track progress. Items to cover may include:
  • Does the payor have a specific format for this process? If so, obtain and use their form.
  • Why is the issue happening?
  • What is the plan to resolve the issue?
  • What is the timeframe for issue resolution?
  • When can you expect to receive correct reimbursement?
  • Will the payor use the claims issue log to reprocess all affected claims?
  • How often will updates be provided on all the above?

Bottom line

A pattern or trend of inaccurate reimbursement is the last thing you want to discover when working claims.  Unfortunately, it happens often.  Prepare for this inevitability by having a process that organizes, tracks, and resolves claims issues with maximum efficiency.  It’s never too early to identify a trend.  Hop on it as quickly as it rears its ugly head.  You don’t want to lose out on revenue because you failed to connect the dots.

Carol Ciluffo – Vice President of Revenue Cycle Management

IT Software Conversion

Managing Your ASC’s A/R During an IT Software Conversion

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Your ASC has decided to take the plunge and transition to a new patient accounting system.   This is no small task.  It requires thoughtful research and planning to make sure the transition is as smooth as possible. 

Plan for a six to nine month exploratory process to research and demo systems designed to meet the needs of your facility.  Involve as many different stakeholders as possible to assist in making an informed decision.  Determine what system will meet your business needs and accommodate employee workflow. 

From a billing perspective, your primary goal is to avoid a decrease in your center’s cash flow.  To achieve this goal, carefully consider the following: 

Electronic claims/statements

  • Will you continue with your current clearinghouse or switch vendors?
  • What will your new electronic data interchange (EDI) testing process entail? When will testing begin?  How long will the testing process take?
  • If your electronic funds transfer (EFT) arrangement is new, will you enroll online or via paper?
  • Will you stagger payer enrollments based on approval timelines to avoid cash flow lag?
  • Is your statement process paper or electronic? How will the process be affected by the change?
  • Are there any modifications required to accommodate your online bill pay system?

Training needed in advance of the go-live date

  • Coding
  • Charge entry/billing
  • Cash posting
  • A/R management
  • Administrative reporting
  • Is the user manual available and up-to-date?
  • Is there an on-demand training option available for current and future staff?
  • How is training scheduled? On-site or via webinar?   What is the course content and how often is it offered?

Strategy for your legacy system

  • How long will it take to work the outstanding A/R in the legacy system?
  • What will the impact be on staff productivity if they need to maintain dual systems for a predefined period?
  • What type(s) of report(s) will you provide to your accountant to convey the A/R being worked in both systems? Will both systems produce comparable A/R data?  If one system reflects gross receivables and the other reflects net receivables, how will you account for the difference?
  • How long will you maintain the legacy system?

Post go-live support and training options

  • Is additional training available?
  • Does online training exist? How robust is the content? 
  • How responsive are system support personnel?
  • How often are system updates rolled out?

The process of moving to a different patient accounting system can be daunting if you don’t do your homework.  In fact, it can feel like a second job.  Prepare your team by keeping them involved throughout the process.  Employee acceptance is a key component to a successful transition. 

Change is hard, but it is rarely without benefits.  You will likely learn a thing or two about your current processes amid the change.  Embrace the opportunity to tighten things up.  Explore better methods to accomplish tasks in the new environment.   Don’t let anxiety run this project into the ground.   Spend the time required upfront to ensure the transition is a smooth one for your surgery center.

Carol Ciluffo – Vice President of Revenue Cycle Management

Payer Meetings

Payer Meetings – Uncovering Valuable Information Hidden Inside Your Aging

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An ASC’s contracts with its insurance carriers state payments on clean claims occur in 30-45 days.  A/R day benchmarks are typically tied to those clean claim expectations.  In a perfect world, clean claims would be submitted 100% of the time and payer payments would release within 30-45 days.   No claims would age over 60 days.  Yet, we do not live in a perfect world.  Unfortunately, many claims age beyond the desired A/R day timeframe.

What is behind payment delays?  Are the claims clean when submitted?  Did the claims meet all requirements specified by the payer to trigger prompt payment?  Finding answers to these questions is best served by conducting payer meetings.

What are payer meetings?

Payer meetings are a deep dive into each individual claim on your ASC’s aging that meet specific criteria.  For example, that criteria could be all claims over 90 days whose outstanding account balances are $1,000 or more. 

Who should attend payer meetings and how often should they occur?

Payer meeting attendees could include your administrator, payer contracting representative, revenue cycle manager, coding and billing staff, and personnel responsible for A/R follow-up.  Ideally, each of these departmental representatives meet every 30 days to uncover issues and provide insights for resolutions and process improvements. 

The purpose of payer meetings may be to determine:

  • If there is a payer trend that needs to be addressed.
  • If there is an opportunity to improve the operative report to satisfy a medical necessity denial.
  • If there is a training opportunity for personnel whose errors are contributing to payment delays.
  • If payer authorization requirements are being met thereby allowing payment to be issued.
  • If payer billing requirements are followed.

Discussion occurs on every claim that meets the criteria, including why the claim remains unpaid, the action(s) taken on the claim to date, the status of the claim, and the likelihood of payment resolution.

Information gathered from this process is invaluable in identifying payer trends.  It also provides concurrent training to all parties involved in the claims process – coding, charge entry, billing, electronic data interchange (EDI), cash posting, and accounts receivable.  Further, it helps develop strategies to deal with appeals and denials. 

Examples of payer meeting findings are:

Issue 1: Payer routinely denies separate payment for implants. 

  • Action: Multiple follow-up calls with the payer revealed the payer inaccurately loaded the facility’s contract, omitting separate implant payment despite an “implants paid separately” clause. 
  • Result: A claims issue log was submitted to the payer’s provider representative.  The payer reloaded the contract with the necessary correction.  All affected claims were reprocessed and implant payments were secured.
  • Process Improvement: Although internal processes did not need to be addressed, the payer meeting created an opportunity to reinforce to attendees how important it is to identify denial trends, quickly bring them to the payer’s attention, and work with the payer toward resolution.

Issue 2:  Claims denied after 30 days for being submitted on the wrong claim form

  • Action: Research of the payer configuration in the patient accounting system revealed the wrong claim type was selected when the payer configuration was created. 
  • Result: All affected claims were refiled with the payer.
  • Process Improvement: A process was created to notify billing personnel when a new payer configuration was created.  Those personnel now review the configurations for accuracy prior to claims submission.

Issue 3:  Multiple claim denials were received on pain management cases based on medical necessity.

  • Action: A coding review was performed on the operative reports to determine what information was needed to satisfy medical necessity requirements.
  • Result: Amended operative notes addressing medical necessity were obtained from the pain management physicians.  Appeals were submitted for payment with the additional supporting documentation.
  • Process Improvement: Consultations took place with physicians to alert them to medical necessity requirements for the procedures performed.  The medical necessity policy was provided to physicians with suggestions on how amended operative notes could substantiate the policy requirements established by the payer.

Issue 4:  Lack of prior authorization on procedures and implants resulted in multiple claim denials.

  • Action: Payer prior authorization lists were researched to confirm prior authorization was required.  Further research was conducted to verify authorizations were obtained.  The research revealed two findings.  First, required authorizations were not obtained by ASC front office personnel and, secondly, facility personnel were relying on the referring physicians’ offices to obtain the necessary ASC authorization.
  • Results: Appeals were sent to the payer requesting retroactive authorizations.  When retroactive authorizations were granted, claims were refiled with the retroactive authorization to secure payment.  When retroactive authorizations were not granted, adjustment forms were completed to write-off the claim balances.  Patients could not be held liable when authorization requirements were not followed by ASC personnel.
  • Process Improvement: Additional training and education was provided to front office personnel to review payer authorization requirements, confirm access to the payer master pre-certification lists, and explain how to use the lists.

The reasons claim payment delays occur beyond the expected 30-45 day threshold involve many parties – from patients who supply inaccurate information at time of service to payors who load inaccurate contract terms to facility and billing personnel who are unfamiliar with the nuances of ASC revenue cycle management.  It is important to take the time to discover the specific reasons related to each case then follow through on issue resolution.  Implementation of process improvements help you effectively address identified issues and proactively manage your facility’s bottom line. 

Carol Ciluffo – Vice President of Revenue Cycle Management

medical coders

Medical Coders – The Front Line of Your ASC’s Reimbursement

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Prior to the advent of electronic claims submission – mandated by the administrative simplification portion of the Health Insurance Portability and Accountability Act of 1996 – many claims submitted by ambulatory surgery centers (ASCs) were coded by business office personnel who either relied upon information from superbills provided by surgery center providers or their own hands-on expertise.  Today, however, submitting medical claims without the benefit of professional coding expertise can negatively impact your ASC’s reimbursement.

If your ambulatory surgery center employs certified professional coders (CPCs), you’ve positioned yourself well.  However, it’s important to ensure their approach is not only outpatient driven, but ASC centric.  ASC billing is unique and has become increasingly complex with movement of high acuity cases from inpatient settings to ambulatory venues. 

Here are some ways to establish a strong team of certified professional coders for your ASC:

Hire smart.

Certified professional coders are bound by the code of ethics established by their credentialing organization. Their certification denotes implied trust.  In other words, you can assume certified coders comprehend the anatomy, physiology, and techniques used in a variety of specialties.  Insist on high levels of CPT, ICD-10, modifier, and HCPCS accuracy.  Put coders through the paces before you hire them.  Have them code sample cases (remove all PHI beforehand) that have been performed in your center and send them to an external auditor to assess coding accuracy.

Perform routine coding audits.

Gauge and manage coding accuracy by auditing often.  Internal and external audits identify educational opportunities and ensure upcoding (billing procedures beyond what is documented) and undercoding (not billing procedures supported by documentation) from plaguing your accounts receivable.

Ensure provider documentation is comprehensive.

Medical coders are not diagnosticians!  Their role is to provide the insurance carrier with a claim that accurately describes the patient/physician interaction. ASC medical coders depend on the information documented within the operative report to establish appropriate billing codes.  When medical necessity denials occur, this can be a sign that the information initially provided in the claim and supporting documentation does not adequately substantiate the billed charge(s).  Therefore, when coders approach physicians to request additional information, they are not impugning the physician’s expertise.  They are likely seeking one or more of the following: 

  • ICD-10 diagnosis codes which require a higher level of specificity and must be incorporated into the postoperative diagnosis.
  • More specific procedure headings that sufficiently support the CPT codes billed.

Coders are trained to rely on the information contained in the body of the report.   If the headings state something that is not reiterated or fully supported in the body of the report, they are not allowed to bill those codes.  To assist them in capturing all billable codes, ensure the narratives in operative reports contain the details necessary to communicate as much as possible about the encounter.

Ensure your coding team knows about new service lines you want to offer.

If your facility is thinking about expansion into new specialties or considering adding high acuity cases, provide ample notice to your coders so they can adequately prepare for these types of cases.  They will need to access additional tools to ensure the correct codes are used to describe the services provided. Further, they’ll want to research how to effectively maximize reimbursement of multiple procedures without improperly unbundling the codes.

Confirm implants will be separately reimbursed.

Forward the vendor cut sheets to your coding team as soon as you begin shopping for emerging technology or new implants.  Coders are not solely exclusive to your back-end billing process.  Involve them early and often.  They can crosscheck medical policies on the front end to prevent facility losses.  

Require your coders to routinely review carrier guidelines and familiarize themselves with payors’ reimbursement habits.

A seasoned ASC medical coder is familiar with carrier guidelines and payors’ reimbursement habits.  Third-party payor expectations are often outlined in your insurance contracts and supplemented by carrier-specific billing manuals. Require your coders to review these often.  Using the correct combination of form type and modifiers will mitigate the risk of claim denials.  Increase your output of clean claims by giving coders access to these tools early.

Make continuing education a priority.

Certified coders are required to amass a defined number of continuing education credits annually to maintain their certification designation.  Support their efforts by routinely enrolling them in courses that bolster their knowledge.  Consider allowing them to obtain specialty-specific certification.  Continuing education and familiarity with Medicare, Medicaid, and commercial medical policies can increase clean claim submissions and reduce preventable payment lags.

Certified coders are key to ensure clean claims and maximum reimbursement are generated for cases performed at your ASC.   Since the ambulatory surgery center is a niche industry, it is important to employ experienced CPCs who are willing to learn the nuances of the ASC billing process.  Collaboration between your coders, ASC leadership. and operations team, fosters an efficient claims process that will enhance profitability.

Bethany Bueno – Director of Billing Operations

Patient Payment Policies

Are Your ASC’s Patient Payment Policies Hindering Effective Collections?

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According to a recent study by Kaiser Family Foundation, an increasing number of insured Americans report difficulty affording health care.[1]  Are you prepared for the impact your patients’ out-of-pocket costs will have on your facility’s cash flow?   Implementing patient payment policies and corresponding processes goes a long way toward effectively managing a growing financial class – patient responsibility.    

Are you familiar with your ASC’s patient payment policies?  Is your board supportive of those policies?  Does your staff follow the policies?  If you answered “no” to any of these questions, there’s work to be done.  Make sure you tighten the gaps.  Educate and train your staff on how to implement the policies effectively.  Your efforts will be instrumental in avoiding an increase in bad debt due to uncollected account balances.  You will also create a better patient experience with your ASC’s billing process.

Let’s review the components of strong patient payments policies and upfront collections.

Creating an effective collections process starts with determining when you need to receive payment from patients.  Best practice is to collect co-payment and deductible portions owed by patients before or on the date of service.  Post your policy at your front desk and in your waiting room.  For patients who do not have insurance (self-pay), secure payment in full on or before the date of service. 

Do your patient payment policies outline what should occur when patients indicate they are unable to meet the terms of those policies?  If so, what steps need to be taken by facility personnel?  Proactively discuss with your facility’s governing board the types of payment plans they are willing to extend to patients.  Furthermore, decide what mechanisms the ASC will use when individual patient payment needs conflict with established policies. 

Other things you can do to ensure successful upfront collections include:

  • Providing patients with an accurate estimate of their responsibility for upcoming care – review these details with them before their date of service.
  • Relaying the types of payment you accept – cash, credit cards, automatic withdrawal from bank accounts, online bill pay portal, etc.   Provide as many payment avenues as possible and make it easy for patients to pay.
  • Developing a well-defined policy for upfront collections. Statistics reveal patients are 90% likely to pay before their visit, 70% likely at checkout, and only 40% likely to pay after their visit.[2]
  • Training your staff to be comfortable with upfront collections – provide collections scripts, customer service training, and role playing opportunities to enhance their skills.

Before finalizing your policies, establish how you will deal with amounts that are billed to but not covered by insurance and are attributed to patient responsibility by third-party payors.  

Some questions to consider are:

  • How long will you wait for the insurance payment before you involve or bill the patient?
  • Will you bill secondary insurance?
  • Will you bill the secondary policy if this information is provided after you billed your patient?

Determine if you will bill exclusively when the secondary policy is submitted at the time of registration. Look at your statement cycle – statements issued once a month are no longer effective.  Consider the frequency of your statements and the number of statements you will send before referring patient accounts to an outside collections agency.

After determining your upfront collections policies, define what past due means for your ASC.  It’s surprising how many patient payment policies state past due accounts will be turned over to an outside collections service but do not adequately define the term past due.  Is it one day past the due date?  Is it ten days after the due date?  If you state accounts will be turned over to collections, follow through.    Establish a policy on how to handle scheduling of patients who were previously turned over to collections. 

Consider the following:

  • Will you collect all amounts owed from past dates of service before scheduling an upcoming case?
  • Will you collect the patient estimate in full with no payment options due to previous collections activity?

To address the questions above, consider a legal review of your policies.  This will confirm you have thoughtfully dealt with necessary items and considered how to handle any problems that may arise. 

Once you have a refined policy in place, post it in your waiting room and on your website.  Also, include it in your patient packets and review it in person with patients and family members.  Have patients sign the policy and any corresponding payment plan agreements, then provide them with a copy. Lastly, send the agreement to your billing department to assist with collection efforts.  Displaying and consistently following your patient payment policies will lead to better outcomes in your upfront collections. 

In these times of rising out-of-pocket health care costs, your ASC’s patient payment policies and upfront collections practices are important to the well-being of your ASC.  Review them frequently to ensure your upfront collections practices lead to an enhanced billing experience for patients and stabilization of your ASC’s revenue.

Carol Ciluffo – Vice President of Revenue Cycle Management

[1] The Henry J. Kaiser Family Foundation: “Data Note:  Americans’ Challenges with Health Care Costs,” 2017 

[2] McKinsey & Company: “U.S. Health Care Payments: Remedies for an Ailing System,” 2009

ASC Trends

New White Paper! Looking Ahead: 10 ASC Trends and Developments to Watch in 2017

By | ASC Development, ASC Governance, ASC Management, Leadership, Payor Contracting, Revenue Cycle Management | No Comments

We are excited to release our latest white paper – 10 ASC Trends and Developments to Watch in 2017.

We are still in the early months of 2017, but it is already shaping up to be an interesting year in health care — one that is likely to be a mix of uncertainties, challenges, and opportunities.

Fortunately for ASCs, they are well-positioned to thrive in the rapidly changing and evolving marketplace.  They may even be able to improve their position by planning for and effectively responding to trends and developments.

The 2017 trends and developments for ASCs identified by our leadership team include a forecast for strong industry growth, interest in adding new specialties, and continued migration of higher acuity cases to ASCs.

Changes in the relationship between ASCs and payors are impacting reimbursement especially in facilities who do not have strong revenue cycle management solutions.  Bundled payment programs and the growing number of self-insured employers continue to create marketing opportunities.

Unfortunately, the continued escalation of the financial responsibility borne by patients present revenue challenges.  And, a rise in cyberattacks has disrupted health care, bringing cybersecurity to the provider forefront.

Finally, educating patients, physicians, health systems, and payors on the value of ASCs remains a top priority. Raising this awareness is crucial to fuel the growth the ASC industry is primed to experience in 2017.

In summarizing what’s ahead in 2017 for ASCs, Trista Sandoval, our Director of Business Development & Physician Relations, said:

“One of our main strategies is to continue to focus on raising awareness of ASCs as a high-quality, low-cost option for care, and doing what we can to drive applicable outpatient cases to our ASCs. That may take the form of helping hospital systems build their own ASCs, educating patients through direct consumer marketing, or reaching out to physicians to build awareness of the ASC setting as a viable option for their procedures.”

Through such efforts, Pinnacle III’s leadership team believe ASCs will thrive in 2017.

To read the full report, download the white paper here: 

The Pinnacle III Marketing Team

ASC Revenue Cycle

Assessing the Health of Your ASC’s Revenue Cycle through Benchmarking

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Carol Ciluffo, Vice President of Revenue Cycle Management for Pinnacle III, is featured in an ASC Focus column. ASC Focus is the official magazine of the Ambulatory Surgery Center Association.

The article, titled “Benchmark Your Revenue Cycle,” is published in the February 2017 issue.

Carol discusses the following topics in the column: the importance of monitoring revenue cycle health, various benchmarks ASCs can consider tracking, how benchmarking can identify opportunities for improvement, and the need to embrace benchmarking results.

To access the article, click here (ASCA membership required).

For more ASC revenue cycle management best practices, please visit some of Carol’s original posts in our blog:

Benefits Approval in ASCs: Pre-Authorization & Pre-Determination Vastly Differ

Billing Solutions: Forensic Collections – Lost Revenue Found

Put the “Revenue” in Revenue Cycle Management from Your Most Important Source: Your Patients

To Audit or Not to Audit – That is the Question

Implant and Supply Reimbursement Blunders Nearly Every ASC Commits

Lockbox Banking

Is Lockbox Banking Right for Your ASC?

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Do you receive payments in the mail from your patients?  Are these payments deposited the same day they are received?  Do you have enough staff on hand to properly process these receipts and adhere to best cash handling practices?  How much time does it take your staff to file or scan the payment documentation that needs to be retained?  If you are struggling with any of these issues, lockbox banking may be a benefit to you.

Lockbox banking is a process in which patients submit payments to a special post office box instead of to your ASC.  Your bank has couriers pick up mail from that box and deliver it to them.  Bank personnel open the mail, scan, and deposit the payments directly into your bank account.  You obtain earlier access to your money and are provided payment information in an electronic format.  These paperless files are then used to post information to your patient’s accounts.

There are pros and cons to consider before proceeding with a process change.  Here is a list of advantages and disadvantages that may help you determine if this payment processing strategy is right for you.


  • Earlier access to your money (typically one to three days)
  • Streamlined payment processing
  • Payments retrieved directly by the bank, reducing possibility of office theft
  • Bank scans all documentation directly into your account
  • Customized remittance processing designed to meet your needs
  • An evolving service that adopts new, improved imaging technology
  • Lockbox location can be chosen close to your facility to shorten mail and receipt time
  • Frees up office resources to handle other tasks


  • Service fees
  • Quality of training and supervision of lockbox bank employees

How do you decide if lockbox processing is right for your office?

  • Perform a time study on your in-house payment process and the associated process costs (staff, supplies, check scanners, mileage/liability for in-person deposit deliveries).
  • Quantify the number of payments and associated payment documentation you receive.
  • Calculate the value of your average payment received via mail.
  • Compare the costs of your current in-house process to your lockbox processing option.
  • Determine if the fee is negotiable.
  • A high volume of small payments may not be worth the cost.
  • Compare the cost of the service to the benefit of earlier access to funds.
  • Confirm the bank’s security policies to guard against the potential for theft internally and by third party courier vendors.

By performing due diligence, you will be able to determine if lockbox bank processing will create efficiencies in your front office and safeguard vulnerable ASC receivables.  This includes freeing up valuable staff resources, eliminating manual processes, and tightening security of the payment receipts.  At the very least, it is worth exploring the opportunity.

Carol Ciluffo – Vice President of Revenue Cycle Management