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Tip: Manage colonoscopy procedure scheduling and benefit verifications

Ambulatory Surgery Reimbursement Update, September 16, 2008

Colonoscopies are one procedure where doing detailed scheduling and insurance verifications on the front end can mean a significant difference in proper reimbursement for the ASC and good future relations with patients. Asking the right questions during the scheduling process is very important to ensure that your ASC gets the reimbursement it expects versus receiving only minimal payment from the payer. Having to seek additional reimbursement from the patient (more than they expected to pay) potentially can cause a public relations nightmare for your ASC.

When a physician’s office schedules a colonoscopy, it is very important for the ASC scheduler to inquire if the colonoscopy is a diagnostic procedure for symptoms, or if it is a screening colonoscopy procedure.

Insurance verification procedures should be thorough to assure proper reimbursement and avoid any surprises on the back end of the reimbursement process. If the case is a screening colonoscopy procedure, the insurance verifier needs to obtain benefits for both screening colonoscopy and diagnostic procedures. Many payers have vastly different benefits for screening procedures than for diagnostic colonoscopy procedures performed for symptoms or polypectomy procedures. This can result in the patient owing much more out-of-pocket for his or her procedure.

It is also very important to properly explain the benefits to the patient prior to performing the procedure. If the scheduled procedure is a screening study, is important to explain the benefits for both screening and diagnostic colonoscopy procedures to the patient in detail, in case a screening study finds a problem. It’s also a good idea to explain the two sets of benefits on a form the patient signs, stating he or she understands. Give the patient a copy, to cut down on reimbursement misunderstandings after the procedure.

This tip is brought to you by Ellis Medical Consulting, Inc.

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