by Rob Kurtz
Susan Charkin, MPH, president of Healthcents, an ASC and physician specialty hospital contracting and consulting group, offers the following four quick tips for increasing collections in your ASC.
1. Avoid retrospective review clauses. It is critical for ASCs to fight to keep clauses out of their payor contracts which allow payors to retrospectively review claims, Ms. Charkin says. When this clause is included, payors can scrutinize claims well after they are paid, identify overpayments and demand the money back.
“A lot of these contracts allow them to go back as far as they want,” she says. “Make sure you either limit or take out retrospective review.”
2. Leverage unpaid claims. When you’re in contract negotiations, if a payor owes you a significant amount of money in unpaid claims, you can use this as leverage, Ms. Charkin says.
“There are certain payors that are notorious for not paying on-time and also not paying you according to contract,” she says.
If you are dealing with such a payor, remind them about the unpaid claims. You can ask the payor to rectify the situation and offer something in exchange, such as your conceding a small increase in payment for a procedure you weren’t hoping to receive anyway.
“Very few people do this but it’s very powerful,” says Ms. Charkin. “You get the contractor to do your dirty work and you don’t have to deal with the claims. A payor would rather pay you what they owe than give you an increase.”
3. Work with your contractor for unpaid claims. It is likely not worth your time to contact a payor’s claims department to follow up one or two unpaid claims as the effort and manpower you put into this will in many cases cost you more than what you collect.
If there are many unpaid claims from one payor, gather these together and inform the contractor you work with about them, says Ms. Charkin. This individual is in a better position to help you resolve the issue, and in such a way that your work is financially worthwhile.
4. Remind payors about late fees. Every state has timely filing payment requirements and your ASC is likely eligible to receive late fees for slow claims processing by payors. This late payment is also possibly a violation of your contract and might be grounds for you to terminate it for cause. While you probably will not want to go out-of-network in most scenarios and are not likely to receive the late fees, these are two issues that give you some leverage over your payors, says Ms. Charkin.
Learn more about Healthcents.