Collecting payment for surgical procedures — whether from government or private payers, self-insured employers, or directly from patients — is a significant challenge for medical practices and surgery centers. Factors including the ongoing COVID-19 pandemic and changes to Medicare reimbursement rates have increased pressure on practices to improve the effectiveness of their billing and collections.
In CMS’ updated 2023 Medicare Physician Fee Schedule, the conversion factor used to calculate physician reimbursement will decrease by $1.55 to $44.06, a 4.48% reduction.
It is crucial for medical practices to understand the complexities of the current billing structure and how each area of patient care can be optimized to reduce administrative burden and maintain an effective revenue cycle. Here are three steps that centers can take to ensure a healthy financial future.
Evaluate Potential Revenue Loss
In an ever-changing reimbursement environment, clarity is key to success. Review the new CMS guidelines, current reimbursement rates, and the previous year’s rates to estimate if your revenue will increase or decrease in the next 12 months.
Prioritize Patient-Centric Billing
Patient education is more important than ever. To comply with the No Surprises Act, which aims to protect patients from surprise medical bills, facilities must provide good-faith estimates for the services they will receive. This is often a confusing and frustrating process for patients, who may not understand what their health insurance will cover and what their out-of-pocket responsibility will be — especially when there are multiple providers and departments involved.
Anesthesia billing can be particularly challenging for patients to grasp. Make patient education a core part of your billing and collections system, explaining procedures in detail, sharing payers’ allowable rate for each service, and answering patients’ questions in advance. Prioritizing patient-centric billing will help minimize misunderstandings and payment delays.
Adopt Billing Best Practices
It requires time and resources to keep up with reimbursement changes and try to capture lost revenue. For many centers, billing and collections with in-house staff is no longer practical, and they benefit from outsourcing it to an expert team. A company that specializes in using human expertise and the latest technology to submit and monitor clean claims, reduce claim denials, and increase timely payments can help your center maximize revenue.
Interested in learning more about the benefits of outsourcing anesthesia? Contact CarePlus.