Value of Revenue Cycle Outsourcing for Surgery Centers During COVID-19
By Caryl Serbin, RN, BSN, LHRM, President and Founder, Serbin Medical Billing
Now that the hold on elective surgeries due to the COVID-19 virus has been lifted, ambulatory surgery centers (ASCs) are reopening. With the worst hopefully behind us, ASCs are well-positioned for the future. Industry experts predict that while surgical volume will likely take some time to return to normal as ASCs work to gradually — and safely — resume operations, what will follow is a sharp increase in cases.
They attribute this uptick in cases to ambulatory surgery centers to the following:
Patients' choosing ASCs over hospitals due to safety concerns and cost savings.
Prior to the discontinuation of elective surgeries, many surgeons had switched from hospital outpatient facilities to ASCs because of safety and patient request.
Third-party payers had already begun channeling more cases to ASCs prior to the COVID-19 recess and experts predict a faster-paced continuation of this trend due to cost savings.
The Centers for Medicare & Medicaid Services (CMS) will continue approving more procedures that can be performed in ASCs because of safety, efficiency, and cost.
Possible loosening of certificate of need (CON) requirements in some states to allow for faster ASC development to handle increased caseload.
All cancelled ASC cases may now be rescheduled, and ASCs will have the opportunity to capture the case overflow from local hospital(s) whose priorities continue to be caring for COVID-19 and other emergency patients.
Jumpstarting the Ambulatory Surgery Center Revenue Cycle
Along with the backlog in elective surgeries, this recess has left most ambulatory surgery centers with a depleted revenue stream. To stimulate cash flow, the initial focus must be on unbilled cases and uncollected accounts receivable (A/R). As ASCs steadily increase their caseload, many will choose to extend hours of operation to include evenings and weekends. These factors will necessitate additional experienced clinical and business office staff, more space for patient care due to social distancing guidelines, and additional spending to address the safety precautions necessary to meet recommendations dictated by the health crisis. To support the work required to meet the high demand for elective surgery, ASCs will need a rapid return of their revenue stream. But there are some barriers you may need to overcome.
The forced closing of ambulatory surgery centers during this pandemic may have resulted in furloughed (laid-off) or dismissal of your ASC's employees so they could apply for unemployment. Is your staff available now to return? Are they willing to return to reduced hours during the ramp-up phase of reopening? Do you have the staffing flexibility if the virus recurs and your ASC is forced to close again?
As the need for additional employees surfaces as caseload increases, identifying and adding experienced clinical and business office employees may prove difficult. In an optimal scenario, hiring experienced, ready-to-go employees would be the preferred solution, but are such individuals seeking employment in your community? Your caseload may grow faster than you can hire staff.
Outsourcing Revenue Cycle Management as a Sensible Surgery Center Solution
More ambulatory surgery centers are turning to outsourcing their revenue cycle management as they focus on opening the patient care areas of their center safely. While there are many reasons to outsource RCM to an independent contracted company, a significant benefit in the current COVID-19 climate is an ASC's need to take advantage of proven experience to stimulate rapid cash flow. Qualified ASC revenue cycle management companies provide a team of experienced personnel whose only responsibility is to deliver timely and compliant coding, billing, and collection services and keep your accounts receivable at or below industry standards.
Two less recognized benefits of ambulatory surgery centers outsourcing their revenue cycle management is 1) the ability to have RCM grow as caseload grows without needing to increase staff, equipment, and business office square footage, and 2) the flexibility to scale back due to new COVID-19 breakouts and possible surge of the virus in the fall and winter.
Let us briefly examine a few of the ways that outsourcing revenue cycle management helps ambulatory surgery centers in resuming their operations during the health crisis.
1. Surgery center billing and reimbursement backlog
As noted, addressing the large backlog of unbilled cases and uncollected accounts receivable must be a high priority. As there was little to no ramp-down period preceding the shutdown of business, there were undoubtedly procedures that were not dictated, transcribed, coded, and billed. In addition, most collection efforts on third-party payer and patient accounts were stalled. An ASC revenue cycle management company will focus on these two areas to help restart cash flow.
2. Surgery center staffing shortage
With reduced caseload and hours of operation, ambulatory surgery centers may find themselves short-staffed, which can contribute to challenges of keeping up with current revenue cycle tasks, let alone addressing the backlog. Thanks to their staffing flexibility, an ASC outsourcing revenue cycle management company can provide the necessary staff to immediately begin tackling the accumulation of unbilled and uncollected revenue to provide a steady revenue stream. The company can also assign RCM staff as needed during the ramp-up period and continuing increased caseload.
3. Increased clinical space
Outsourcing revenue cycle management permits ambulatory surgery centers to reduce their business office staff. This allows ASCs to increase square footage dedicated to patients and care, such as expanding reception areas (waiting rooms) to better ensure social distancing and allocating space required for pre-procedure screening and testing.
How Outsourcing is Benefitting Ambulatory Surgery Centers
As the owner of Serbin Medical Billing, an ambulatory surgery center-specific revenue cycle management company, I can report that our clients have told us that they are even happier with their decision to outsource their ASC's RCM. Our infrastructure and emergency planning policies and procedures provided remote support capabilities, thus preserving their revenue stream in the weeks that followed the shutting down of elective surgery. The Serbin Medical Billing disaster plan covers all contingencies due to any type of business disruption, including major health crises. The disaster plan includes remote (i.e., work-at-home) plans, backup IT service, business cell phones for all employees, faxing capability, and employee training in safely accessing client servers. Although the unplanned COVID-19 virus shutdown of businesses caught us all by surprise, it validated that in any situation, we are equipped to provide uninterrupted service to our clients.
Our clients have also told us that reopening their ambulatory surgery centers has proven easier as they do not need to worry about cash flow. As noted, Serbin Medical Billing's remote capabilities preserved our clients' revenue streams during the COVID-19 forced business closure. They also appreciate how we adjust our services and support to align with their modified caseload requirements and our ability to move fluidly with them as they ramp up.
Newfound Appreciation for Outsourcing
The COVID-19 forced business closure highlighted the types of businesses that are positioned to adapt and thrive in this "new normal." In the ambulatory surgery center industry, the likes of revenue cycle management, IT services, and communication and collaboration platform companies (e.g., Microsoft, Skype, Zoom) are emerging as winners.
During this time, I have received a wave of phone calls reflecting a new attitude toward outsourcing. Revenue cycle management outsourcing was already growing in popularity. This unexpected interruption has only furthered interest and appreciation.
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We Are Here to Help Your Ambulatory Surgery Center
Thanks to our concierge-type business plan, Serbin Medical Billing is well-suited to help those ambulatory surgery centers looking for an all-encompassing revenue cycle management company partner. We do not provide conveyer-belt billing; rather, we provide extra services not delivered by other surgery center billing companies. We not only provide comprehensive RCM services, but to ensure optimum reimbursement and a consistent and dependable revenue stream for your ASC, we also aid in all areas of the business office.
As essential components of "The Serbin Difference," we provide the following unique, value-added services at no additional charge:
Fee schedule: Audit current fee schedule and recommend applicable changes/updates. Assist new centers in development of fee schedule. Continued monitoring and updating assistance as payer rates change.
Managed care assistance: Guidance on appropriate rates/terms for your area and specialties. Provide insight into payer trends, assist in contract enrollment, and assist in managing contract violations.
Policy and procedure manuals: If needed, provide detailed business office policies, procedures, and forms which meet regulatory compliance guidelines.
Workflow: Recommend products/policies that help streamline workflow (insurance verification products, banking options, patient payment services and billing software), as needed.
Clearinghouse: Manage clearinghouse setup, including appropriate options, integration, and payer enrollment.
Business office staff recruitment: Provide business office staff hiring recommendations and detailed job descriptions and assist in education and training.
Billing system software: Assist in software setup, loading of contracts and fee schedule, and updating necessary data tables.
Provider education: Identify and provide educational resources for providers based on denials of claims received as well as detailed dictation requirements.
Examples of special services provided to our surgery center clients during the virus recess include solving IT problems, providing a policy to clients outlining acceptable patient population based on safety guidelines, and providing a policy to clients regarding temporary "no patient collection contact during pandemic" per government stipulation. There was no automated answering of phone calls from clients and patients as we maintained our staffing to ensure someone was available to answer calls and provide that valuable and appreciated human contact. We did not change how we handled patients' inquiries and they remained unaware that business was being handled remotely. Our clients let us know how grateful they were and continue to be for the smooth revenue cycle operations during the health crisis.
Bright Future for Ambulatory Surgery Centers
Despite the pandemic and uncertainty of possible additional virus-induced closures, ambulatory surgery centers will undoubtedly thrive again. Outsourcing will help ensure uninterrupted revenue cycle tasks, continued revenue stream, and a faster, safer, a more successful return, and an even stronger future.
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