Running a successful ambulatory surgery center is tough. From managing costs to tracking metrics to ensuring smooth flow of revenues.
An optimized billing cycle results in a regulated reimbursement cycle.
A more basic and often neglected aspect of the billing cycle is the lag days analysis. Most centers are unaware of the lag between the date of encounter to actual claim submission. Lag days lead to an uncertain revenue cycle.
Problems with an uncertain revenue cycle.
1. Revenue prediction becomes difficult.
2. Revenue cycle is never standard.
3. Identification of problem areas becomes strenuous.
Tackling lag days.
Ideally, submit all claims within 24 hours of the date of service.
If this isn’t happening, there are only two possible scenarios:
Either physicians are not completing their charts on time or the claims are not sent on time.
Here are six quick tips to manage lag days:
1. Try to complete encounter documentation while you see patients. For consultations, enter the consultation and diagnosis codes during or soon after the visit. For procedures, aim to complete all encounter documentation immediately or before the end of day.
2. Make most use of technology. Invest in an EHR/practice management software that integrates billing. Using a mobile solution can help you complete billing on the move.
3. Customize encounter sheets or EHR modules to match your style of work and lower the time spent on each case.
4. Automate the billing cycle wherever possible. Use OCR software to extract relevant text from scanned encounter sheets. Couple it with custom automation scripts to document CPT and ICD codes within an EHR/PMS.
5. Use a rules based engine for quality. The engine cross-checks all claims with coding guidelines for compliance.
6. Use a real-time eligibility tool to verify coverage details before and at the time of service. This activity will curb charge lag due to missing coverage and benefits.
Establish benchmarks on the acceptable lag limit for submitting claims. Maintain and track the lag day report and work on efficiency.