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Case Study:
Mississippi Surgery Center
OVERVIEW
A Mississippi hospital-physician, joint-venture, multi-specialty ASC had been operating for 14 months. The hospital partner engaged Serbin to evaluate the ASC business office because the center was not achieving projected revenue.
SERBIN INVOLVEMENT
Evaluation of the center revealed a number of reasons for negative cash flow:
- Fee schedule far lower than normally seen in an ASC
- Managed care contracts with low rates and unfavorable terms
- Improper billing/coding practices
- Managers with no ASC experience
- Inefficient use of staff
- Appropriate structure and policies and procedures not in place
A sample review of coding and billing found unbilled revenue due to:
- Bilateral procedures — second side not billed
- Billing from operative note title only
- Coding review revealed errors with estimated loss of allowable net revenue of over $34,000
- > 1-year old accounts review revealed no payment/not rebilled, with loss of gross billings of nearly $80,000
- More than 10 patient accounts not paid or rebilled, surpassing $21,000
- Numerous balances never transferred nor billed to secondary insurance and/or patient
- Non-compliant ASC coding and billing due to inequity of charges, inequity of balance billing and errors
SERBIN DIFFERENCE
The ASC outsourced revenue cycle management to Serbin. The results were as follows:
- Within three months, the ASC was operating in the black for first time
- Gross charges tripled
- Average gross charges per case doubled
- Collections increased more than 250%
- Profit increased more than 400%
- Net income/case increased more than 300%