Becker's ASC Review

21 Thought Leadership 3 ASC administrators' thoughts on managing prior authorization By Carly Behm T he process of obtaining prior authorization is chal- lenging for some ASC administrators also tasked with other financial duties. Here's how three ASC leaders are managing prior authorization: Note: Responses were lightly edited for style. Gerard Bullaro. Administrator at Wellness ASC (McKin- ney, Texas): As a new ASC and struggling with razor-thin margins, we decided to hire a separate preauthorization specialist. Before this, we had four cases that fell through the gaps. These were spine cases, and we did surgeries thinking they were authorized but actually were not. Our staff at this time did not have the skill level to handle this complex procedure, and we lost revenue. Since we hired an additional person to handle this task, we have had 100 percent compliance. With adding additional specialists and growing our volumes for 2021, we're looking at doubling our case volume. Margins are always going to be tight, and it's worth the extra cost of an additional per- son. It more than pays for itself. Brock Kreienbrink, MSN, RN. Administrator at Outpa- tient Surgery Center of Central Florida (Wildwood): Prior authorization management is critical to the success of any ASC. Poorly managed authorizations can have a devastating impact on the finances of ASCs. To know the extent to how it can affect the finances at an ASC, administrators will need to know their patient populations in their market. At our center we have a heavy Medicare market (close to 70 percent market share); however, there is a huge push for managed care, causing our market share of Medicare to shrink over the next five years. When a procedure is performed without the correct authorization, the ASC not only takes a loss on the revenue, medical supplies and labor — it decreases or eliminates profit margins on other procedures. The impact can be far-reaching, depending on the procedure mix, which makes it extremely hard to place a number on it. Raghu Reddy. Administrator at SurgCenter of West- ern Maryland (Cumberland): The prior authorization is a critical step, as the payers will deny the payment if proper authorization is not obtained. Based on our payer mix, we have to authorize 45 percent of our cases at our multispecialty center. We pay close attention to the prior authorization pro- cess, and the impact on our revenue is minimal. We would notify the physician and the patient if the authori- zation were delayed or denied. n These issues can hijack a great ASC accreditation survey By Patsy Newitt T hree ASC leaders spoke with Becker's ASC Review on common mistakes they see when dealing with accreditation compliance. Note: These answers were edited lightly for clarity Taylor Burnett. Association President of the Mississippi Ambulatory Surgery Center Association: The biggest mistake I see is not designating a point person who is allowed the time to get to know and work through the guidelines to make sure you are in compliance. The same person also needs to run point on the survey. Meredith Warf. Administrator at Mississippi Sports Medicine and Orthopaedic Center (Jackson): As the advanced accreditation certificates become more prevalent and expected among payers especially for value-based care, the administrative burden of the rigorous requirements can be daunting. The ASC is always leanly staffed, so adding personnel is an unexpected cost sometimes required. That said, it is easy to focus on the increased documentation requirements in lieu of actual operational changes that pro- duce the quality measures. The investment on the front end in these resources and the time required to create scalable processes is worth the trouble. Robert Lerma. Administrator of Blue Springs Surgery Center (Orange City, Fla.): The biggest mistake I see is not reading nor understanding the chapters of the accreditation manual, which usually results in center policy and proce- dures not reflecting the changes or updates in compliance. You should also communicate with the center staff to ensure that they know where to research information regarding accreditation compliance or center policy and procedures. No one should be expected to have this memorized, but it is expected to know where to retrieve the information and ask questions if necessary. n

• Cover