Why Today's Environment Further Supports the Value of ASC Outsourcing
By Caryl Serbin, RN, BSN, LHRM
As COVID-19 restrictions are relaxing, the demand for outsourcing revenue cycle management (RCM) continues to increase. Residual challenges resulting from the COVID pandemic remain, and ambulatory surgery centers (ASC) are looking for solutions. The current employment environment is experiencing a shortage of qualified clinical and revenue cycle staff, leading to retention and hiring challenges. If your center is fortunate enough to find acceptable job applicants, they come with higher wage and benefit demands. Employee health insurance costs have skyrocketed, and paid time off has increased commensurate with higher wages.
In addition, ambulatory surgery centers are facing general inflation costs in services and supplies. The pending implementation of ICD-11 and the need for compliance with the newly enacted "No Surprises Act" also contribute to the obstacle of recruiting "experienced" revenue cycle staff.
As ASCs are exploring their recruitment options and running into roadblocks, many are realizing that, in addition to providing a resolution to their search for dependable revenue cycle personnel, revenue cycle management companies provide a host of additional benefits. As a result, many ASCs are turning toward outsourcing their RCM. With one less thing to worry about, the center's providers and staff can concentrate on the patient's positive clinical experience and outcome without having to worry about maintaining a healthy revenue stream.
On top of peace of mind in delivering the compliant, accurate and timely coding, billing and collections ASCs need to remain viable and profitable, leading surgery center revenue cycle management companies can provide much more. Let's briefly look at some of the valuable services and benefits that may accompany outsourcing RCM.
1. Update and maintain ASC fee schedule
The center's fee schedule is the foundation of reimbursement. It is imperative that the fee schedule reflect a fair and current dollar amount for each procedure. Accurate fees are paramount in negotiating managed care contracts and compliance with the No Surprises Act. An ASC RCM company can help ensure your center's fee schedule is always kept current.
2. Update and maintain ASC managed care contracts
As inflation affects supply and labor costs, it will likely become necessary to renegotiate reimbursement rates for your top procedures — especially high-cost procedures. The RCM provider can review case cost versus reimbursement amount and make recommendations about necessity of contacting managed care companies to renegotiate these rates.
In addition, the RCM company can continue to update your business management software with new rates and new procedure codes.
3. Provide compliant and secure ASC revenue cycle functions
With federal and state regulations constantly changing, and as billing complexity increases, a good ASC RCM services provider can provide ongoing education to its employees to keep them abreast of these requirements and ensure compliance in billing while providing patient privacy for clients.
4. Provide experienced ASC RCM staff
By partnering with an ASC revenue cycle management company, you are essentially hiring a team of experienced surgery center professionals. This frees your center's business office staff to focus on scheduling, patient registration, answering phones, insurance verification, customer service and more.
Additionally, outsourcing eliminates the necessity of searching for qualified and experienced coding and billing personnel. Reducing the amount of in-house business office staff decreases business office staff salaries and benefits, reduces the need to purchase furniture and equipment, and may allow you to allocate more of your square footage to clinical services.
5. Manage accounts receivable (A/R)
An RCM company's certified coders provide optimized coding, which results in your ASC receiving the reimbursement it deserves. Timely and accurate electronic claim submission, swift collection efforts, timely payment posting and prompt denial follow-up lower A/R and maximize cash flow.
These efforts will proceed uninterrupted. Why? Outsourcing companies concentrate solely on coding, billing and collections with no other business office responsibilities or interruptions, such as scheduling and following up with patients, and taking lunch breaks and time off.
Achieving ASC Revenue Cycle Peace of Mind
Once you have identified the right revenue cycle management company that can meet your needs and transferred these labor-intensive RCM responsibilities from your center to this new extension of your business office, you will be able to shift your attention to your ASC's other pressing needs, all while having peace of mind that your center's revenue cycle performance is in great hands.
