How To Improve Patient Collections at Your Ambulatory Surgery Center

By Carol Ciluffo, Director of RCM and Stacy Danahy, RN, VP of Operations

How a sore shoulder delivered some sweet RCM relief at one ASC.

Recently, Stacy was advising an ASC that had recently transitioned from being a hospital outpatient department (HOPD).

As she was working at the center, years of wear and tear on her shoulder were taking a toll. She needed surgery to resolve some serious shoulder pain.

Coincidentally, ASC had a top-notch shoulder surgeon who could help her, along with an amazing clinical team. Stacy knew that the ASC would do a great job, so she opted to have the surgery performed there.

Stacy wanted to be treated just like any other patient. “I want to go through the normal patient experience,” she told department heads.

Along the way, Stacy experienced every step of the ASC’s revenue cycle as a patient does. When she encountered business processes from a patient’s perspective, she found ways she could heal the ASC’s revenue cycle just as the surgical team was healing her shoulder. She called in an expert colleague to help, Compass RCM director Carol Ciluffo.

Pain Point: Point of Service Collections

The step in the revenue cycle that needed the most work was patient collections, also called upfront collections, point-of-service collections, POS collections, patient financial responsibility, and out-of-pocket costs. Whatever your ASC chooses to call it, you must collect it–or arrange to collect it–well before the surgery begins.

“Once the patient has left the surgery center, you have less than a 30 percent chance of collecting what the patient owes out of pocket,” Carol says.

The facility that healed Stacy’s shoulder had just recently converted from an HOPD to an ASC. When they were working as an HOPD, business office staff had not prioritized upfront collections as much as an ASC absolutely must. And there lay the challenge, says Stacy. Staff needed to adapt to necessary changes in messaging. Some staff were afraid they would upset patients and physician office personnel by having financial conversations upfront. They needed to change their mindset.

Business office staff rose to the challenge and mastered these conversations: 35 percent of the ASC’s total collections are patient collections, Carol says.

Back when they were an HOPD, the RCM team spent inordinate amounts of time chasing patient financial responsibility after surgeries were over. Now they are much more effective–and much happier.

Stacy, Carol, and the RCM team established these best practices to improve their patient collections rate, and you can too at your ASC.

Begin the patient financial responsibility conversation in your ASC’s brochure and on your website.

Often, the patient’s first exposure to your ASC is the brochure they get at their doctor’s office. It might showcase the ASC’s excellence, let the patient know what to expect before, during, and after surgery, and give them driving directions and parking information. The brochure is also a great place to explain how the patient will pay for the ASC’s services.

Look at how your brochures, website, and other patient-facing materials explain patient financial responsibility. If you feel like you need a little help, here is some sample language that you can adjust for your own ASC

Schedule the surgery at least two weeks before the surgery date.

Sometimes surgery is urgent, and this window of time is not possible; however, most surgeries that take place at ASCs can be scheduled well ahead of time.

Whether the scheduler is in the physician’s office or at the ASC, it’s a good time to explain the facility fee to the patient and remind them that their portion of the payment is due before the surgery begins. It’s also a good time to let the patient know how and when your financial team will contact them with the amount they owe.

Let the patient know how your ASC communicates what they owe out-of-pocket.

Your odds of collecting upfront are higher if you provide multiple, easy opportunities for the patient to pay out-of-pocket. Many patients–especially if they are Gen X or Millennials, prefer to pay online and often do.

But sometimes patients are wary of email, text, or phone messages that ask for payment, even if the messages lead patients to your secure financial portal.

There are good reasons for patients to be cautious. Texting scammers stole more than $330 million from Americans last year, the FTC reports. Other fraudsters deploy email, social media, and phone calls. Everyone receives and avoids scam messages all the time, which makes it much more difficult for legitimate businesses trying to collect for the services they are providing.

To increase the odds that your patients will know messages are from your ASC and not a scam, make sure that texts and phone calls come from a local area code, even if you outsource your billing, Stacy suggests. Automated phone messages should not be generic recordings.

Instead, automated messages should help patients feel confident that they have reached the correct place: “You have reached the [insert ASC name here] insurance verification department,” for example.

As soon as you know what the patient will owe out of pocket, let the patient know too.

“It is important to give the patients as much notice as possible so that they have time to make payment arrangements,” Carol stresses. “Not everyone has easy access to a large sum of money on short notice.”

Often your business office will know the patient's financial responsibility amount much sooner than the minimum time frames Stacy and Carol recommend, especially if there are more than two weeks between the scheduling and the surgery. Contact the patient as soon as you know so that they have time to plan, Carol urges.

Verify insurance as soon as surgery is scheduled.

Even if the physician’s office has already provided it, someone from your ASC’s business office should verify each patient’s insurance information. Sometimes the information the doctor’s office provides is out-of-date or incorrect. To ascertain what the patient owes, it’s best for your ASC to have direct access to everything on the patient’s insurance card, including numbers to call if a conversation with the insurer is necessary.

Call the patient as soon you verify insurance.

Let them know that their pre-procedure billing statement is available on their patient financial portal, where they can pay securely. Let them know you’ll send them a link to the portal via text, and let them know the number the text will come from. Give them time to ask questions.

Tip: A patient who has had a lot of recent medical care may wonder why they haven’t yet met their deductible. They may well have met the deductible, and the insurer has been slow to post recent activity. If you think this might be the case, give the patient the opportunity to present proof of pending claims.

If the patient says they can’t pay, remind them of their contractual obligation with their health insurance carrier, Stacy suggests. Let them know they have two options for satisfying this obligation.

1. They can reschedule the surgery for when they are able to pay; or
2. They can put a credit card on file to pay in installments set by policy. Just make sure your extended payment policy doesn’t go on for too long of a term, Carol warns. You might also give them information about low-interest healthcare loans that your ASC knows are reputable.

It’s important to make sure that everyone involved with caring for the patient—physician physician’s office, and ASC–is aligned on your upfront payment policy, Carol advises. That way, no one is surprised or angry when a surgery needs to be rescheduled because of payment issues.

Provide patient registration staff with a daily list of people scheduled for surgery and how much they owe out of pocket.

If the patient doesn’t pay over the portal prior to the procedure, it’s up to your registration desk staff to make sure their out-of-pocket payment doesn’t fall through the cracks.

Help your front desk by providing a list of patients scheduled for surgery that day, your ASC’s previous communications about what they owe out of pocket, how much your ASC has collected, and, if applicable, how much they owe.

Remind them of the details they heard a few days ago with phrases like “Your insurance carrier has let us know how much you owe out of pocket for surgery facility fees and your responsibility today is …”

Each station at the registration desk should be able to run debit and credit cards and print out receipts.

Looking for more expert tips on how to improve RCM at your ASC? Check out these templates that you can adapt for patient-facing communications. Contact us to learn more.

Our mission is to create strong partnerships that improve the lives of patients and providers.

Compass Surgical Partners