Issue link: https://beckershealthcare.uberflip.com/i/1454979
16 Executive Briefing: SPONSORED BY I f you're going to entrust your ASC billing to another company, you're going to want that company to be experts in revenue cycle management. That may seem obvious, but what can be a difference-maker between whether the company takes your ASC's revenue cycle performance to a higher level or leaves you in worse shape is the type of expertise the company brings to you. After all, ASCs are not hospitals or outpatient departments. ASCs are not medical groups. ASCs are unique in numerous ways compared to other organizations. That's why the company you partner with for RCM services must have expertise in those areas of ASC operations that can affect bottom line success — not only in terms of revenue generated and maximized but also ensuring revenue is captured in a manner that's appropriate and does not put you at risk. Here are five areas of expertise to look for in an ASC billing company. 1. ASC-specific RCM For a billing company to deliver the results a center needs to remain profitable, the company must understand the revenue cycle processes and components specific to ASCs, including how each affects the revenue cycle and what's required to navigate and factor them into a center's billing program. For example, an RCM company must understand: • important financial key performance indicators and metrics; • how procedures are covered by Medicare and commercial payers; • how commercial payers view ASCs within their book of business and calculate reimbursement; • how supplies and devices are factored into reimbursement; and • contractual language and how to load contracts. 2. ASC-specific qualities A billing company cannot effectively support its ASC clients if it does not have a strong grasp of what makes surgery centers unique beyond specific RCM qualities. Understanding this uniqueness — and the characteristics it encompasses — is essential for everything from collaborating with ASC staff, to identifying coding and billing opportunities and mistakes, to knowing how to approach patient collections. Such characteristics include the specialties and procedures appropriate for ASCs; importance of leanness for staffing, space and budgets; and processes for purchasing high- cost medications and implants as well as investing in capital technology and equipment. 3. ASC-specific practice management systems The initial days and weeks of an ASC's collaboration with its billing partner are vital to short- and long-term success. This is when foundational processes are established between business partners and when patient and financial data are shared by the ASC and assessed by the billing company. Few things can stifle this work like a company's lack of familiarity with the ASC's practice management system that captures the data required for the company to deliver revenue cycle services. If the system is new to the company, the interfacing necessary for end-to-end data integrity will need to be developed — if even possible — and billing staff will require training to learn the system. Such a lack of understanding can slow productivity and performance while increasing the likelihood of errors that contribute to claims delays, denials, missed billing opportunities and other problems. 4. Compliance Beyond helping its ASC clients get paid for procedures, a billing company must ensure all processes supporting RCM are compliant with rules and regulations. In addition, a good billing partner will support an ASC's other compliance efforts and initiatives. Compliance concerning RCM encompasses a wide range of issues. First, there's coding and billing. Coding is a complicated process, with rules that undergo frequent changes. An ASC billing partner should employ experienced, certified ASC coders who are kept abreast of rules changes. Knowing how to bill one payer does not equate to knowing how to bill all payers. While billing rules sometimes overlap between payers, there are typically differences that must be understood for ASCs to submit clean claims and receive correct payments. Billing companies should employ billers with ASC-specific billing expertise, including billing multiple payer types and plans. Compliance with documentation requirements is also essential. An ASC billing partner should have processes that prompt its staff to verify they have received necessary documentation prior to claim submission and submit this documentation with the claim. Then there's HIPAA compliance. An ASC billing partner should be willing to sign a business associate agreement, undergo an assessment of its compliance with HIPAA regulations, and share how it maintains data integrity and can prevent and detect data breaches. The importance of ASC-specific expertise for billing success By Ken Bulow, executive vice president of operations, Surgical Notes