8 Important Tools to Help Your ASC Maximize Profitability
By Caryl Serbin, RN, BSN, LHRM
As the founder and president of an ambulatory surgery center-specific revenue cycle management company that has served the ASC industry for nearly 20 years, I have determined the best ways to make my company more efficient and financially healthy. In this article, I will share my experience and opinions on the tools your ASC can use to help enhance your revenue stream.
ASC Software
The first, and I think the most important tool to choose, is the software package that will help your ambulatory surgery center run smoothly in all aspects of its operations, from clinical, inventory, and medical records management to business office and revenue cycle management (RCM).
Choose a comprehensive software platform designed specifically for ambulatory surgery centers. Look for a software system that provides clinical and RCM functions. (Note: This ASC software checklist can help with your research)
As an ASC billing company, we work with many clients' software systems, which gives us a unique viewpoint when determining what functions we feel are necessary for surgery centers to work more effectively. They are as follows:
Ease of use: Set up of libraries (data tables), such as insurance contracts, fee schedules, and others, should be simple and efficient. Management functions, such as oversight and audits, need to be easy to perform. Screen flow should be efficient, reducing workflow time.
Revenue cycle tasks: Ideally, the workplace desktop should allow for management oversight of scheduling, verification, billing, and collections. Revenue cycle modules should be arranged simply and provide efficiency in coding, claim submission, payment posting, and collections. The system should have the ability to automatically upload to the clearinghouse to reduce manual workload. Display of the patient's account should show multiple visits separately as this makes it easier to visualize amounts owed for each visit. One of the most important facets of the ideal software system is its reporting module. Reports should be available in all formats (e.g., PDF, CSV) with filtering options permitting choices by billing periods or date of service/transaction posting.
General: Software should be server or cloud based, which will allow your ASC to choose whether to invest in an in-house server or not. Customer service support should be immediate, with no delay and no communication issues. The software company should have a history of successfully serving ASCs, a spotless reputation, and excellent customer reviews that can be verified.
Clearinghouse
Our company has used several clearinghouse systems. In this digital age, your ambulatory surgery center should search for a clearinghouse with an efficient platform for accurate and quick claims submission. At a minimum, the system should be able to process and track all claims submitted. It should be able to scan for submission errors and immediately return claims with errors identified for ease of correction. The system should track and provide a clear report/receipt for each clean claim accepted by the clearinghouse and forwarded to and accepted by the appropriate third-party payer.
Patient Insurance Verification
Over the years, I have stressed the importance of insurance verification and patient financial counseling prior to the date of service — which have taken on greater importance as patient out-of-pocket spending has surged. These tasks are critical to successful upfront collections and receiving the full payment owed to your ASC. Finding personnel who will perform this work diligently and educating them is time-consuming and expensive. Although there are several companies offering eligibility verification, these only check the information available online at third-party payer websites — the same information available to your staff.
Look for a company that provides your revenue cycle staff with current patient insurance eligibility and financial responsibility. The company should also identify patients who will require financial assistance and directly provide these patients with payment and financing options available for your ASC. This will significantly reduce your staff's involvement in difficult patient conversations and assist in providing financial solutions.
Pre-Registration
In this era of online communication, I recommend that your ambulatory surgery center maintain a current website that describes your facility, its providers, specialties served, and procedures performed. To save patient and staff time on the day of the procedure, include a patient-friendly online registration form to avoid requiring the patient to fill out the form in the office. Your business office will benefit as it can have the patient's electronic chart partially completed prior to their arrival.
Payment Portal
Because of the preponderance of patients paying their financial responsibilities with credit or debit cards, I suggest that you have a secure online payment portal accessible through your website. This allows pre-payment of deductibles and co-pays as well as the patient's balance due following reimbursement by their insurance company.
Lockbox
Most banks offer lockbox services. These are a secure way to transfer funds from third-party payers directly to your bank. This allows for faster availability of funds, lessens chance of loss or delay due to mailed payments, and eliminates the need for staff having to prepare and take deposits to the bank. The lockbox service provides timely reports of deposits showing patient's name, payer's name, and amount deposited, allowing payment posters to easily post payments to correct accounts.
Collection Agency
Your ambulatory surgery center's revenue cycle staff spends an inordinate amount of time trying to collect outstanding patient balances with little or no positive results. This utilization of your staff is wasteful and costly. Third-party payer collection agencies are not just for deadbeat accounts anymore. Consider contracting with a reputable agency that will work these patient accounts for just a small percentage of what you would pay to have your staff perform these tasks. Not only will this save you money, but it will also free up staff to perform more worthwhile duties. In addition, these account balances will be removed from your open accounts receivable, giving your center a more realistic view of anticipated revenue.
ASC Revenue Cycle Management Outsourcing
The ultimate tool to improve efficiency and help guarantee your ambulatory surgery center collects all of the reimbursement you are owed is by outsourcing your revenue cycle management to an experienced RCM company. The following are just a few of the significant benefits your center can gain from outsourcing:
Outsourcing provides your surgery center with access to a full team of reimbursement specialists, including certified coders, experts in managed care and Medicare reimbursement, and experienced insurance and patient collectors. It is sometimes difficult for ASCs to find experienced personnel to provide the necessary services to keep coding and billing compliant, coding optimized, and collections current.
Outsourcing can alleviate disturbances in your business office caused by vacations, illness, staff turnover, and training of new personnel. Knowing that you're never without members of your billing team is an often-overlooked value of outsourcing.
Optimized coding by a knowledgeable certified coder can often increase revenue, possibly offsetting the full fee of outsourcing RCM services.
Outsourcing can free up your staff members as they do not need to answer billing questions if patient calls are directed to the outsourced billing office. In addition, third-party payer denials and incorrect payments cost your RCM staff excess time and decreases collection efficiency. In general, outsourcing to experts decreases these time-consuming errors and creates more stability in your cash flow.
Ambulatory surgery center billing continues to increase in complexity, due in part to ever-changing regulatory and payer requirements. To remain compliant, it is necessary for your billing staff to monitor rules — in addition to performing their other billing tasks. Outsourcing alleviates the need for these time-consuming processes and can give you piece of mind. A billing company should have a written compliance plan in place and the reimbursement team assigned to your account should be tasked with closely watching for changes and undergo regular audits to best ensure compliance.
Outsourcing companies can often lower the days your money remains in accounts receivable (A/R), catch incorrect payments and correct them promptly, optimize coding, and perform immediate and thorough appeals. This, along with timely and effective collections follow-up, can convert your billing department to a profit center as opposed to a cost center.
An effective ASC revenue cycle management company can increase your revenue and provide your surgery center with a dependable cash flow.
Need help with your research? Please reach out!
The above provides a list of important areas to consider for every ASC that is trying to improve its efficiency and optimize reimbursement. Although the recommendations associated with these categories are generic, I have specific suggestion for most of these and will be happy to share them with you. Fill out the form on this page and I'll be in touch to provide my recommendations.