Becker's ASC Review

10 EXECUTIVE BRIEFING 4 EXECUTIVE BRIEFING 3. Proper reimbursement and collections Another growing challenge for ASCs — and one that further strains cash flow — is collecting from payers and patients what centers are rightfully owed for services rendered. Outsourced billing helps ASCs capture the money they deserve. On the payer side, an ASC billing partner will employ certified coders and knowledgeable billers with surgery center- specific expertise. This extends to coding and billing for ASC specialties and procedures, multiple payer types and insurance plans (and their often-complex requirements), and implants and biologics. Outsourced RCM staff contribute to a high rate of clean claims that reduce time to payment and likelihood of payment errors and oversights. On the patient side, consumers are shouldering more of the cost of their care. Outsourced billing companies have extensive experience working with patients to ensure they cover all their associated expenses. These companies implement procedures for eligibility verification and leverage technology internal staff can use to verify insurance information and determine coverage. Such solutions can often estimate a patient's financial responsibility as well. The patient-focused efforts of ASC billing staff also include providing timely, accurate estimates; initiating successful pre-procedure collections based upon these estimates; and following up with patients to collect on a balance. 4. Payer rules ASCs are increasingly struggling to determine, understand and follow payer rules, as requirements differ between payers — both commercial and federal — and undergo frequent and often unclear changes. ASCs must carefully follow payer rules to submit clean claims, avoid denials and requests for further information, and receive timely payments. Rules compliance can become more complicated when a procedure requires secondary and tertiary billing or includes the use of an implant or biologic. To avoid mistakes and oversights associated with payer- specific rules, ASC outsourcing companies keep their staff current on payer rule changes. These revisions are identified through several, ongoing efforts, including reviewing payer announcements, monitoring payer trends across client facilities that may indicate a rule or expectation change, and communications with payer representatives. This continuous work also helps ASC billing companies ensure clients do not miss new billing opportunities and are consistently paid what they deserve. If payment is incorrect, ASC billing companies have processes in place to quickly flag the wrong amount and execute outreach to payers to collect money owed. 5. Growth opportunities The good news for ASCs: The ongoing migration of care into surgery centers means there are tremendous opportunities for growth. Consulting firm Sg2 projected outpatient surgical volumes will grow 18% by 2033 and ASCs will see 12% growth in the next five years, and 22% growth in the next 10 years — and this projection was made before CMS approved total shoulder replacements for Medicare patients in surgery centers. The bad news is that achieving growth has become more difficult due to the challenges discussed above, as well as others. Outsourcing billing is helping ASCs more successfully pursue and capitalize on growth opportunities. For example, with outsourced RCM, ASCs can free up valuable square footage that may be turned into clinical space to accommodate more case volume, new specialties and procedures, and larger equipment. If a new specialty is added, outsourcing eliminates the need to find revenue cycle staff with knowledge of the billing intricacies or train existing staff in these specific, often complicated requirements. Outsourcing also alleviates the workload of ASC leadership, allowing them to develop proper growth plans more effectively. Leadership is also freed up to work more closely on physician recruitment, equipment research and purchasing, clinical staff hiring and training, and other responsibilities when executing growth plans. As an ASC expands, outsourced billing eliminates the need to find, hire and train new RCM staff. A center can also take solace in knowing its outsourcing partner is prepared to deliver the necessary revenue cycle services to maximize the bottom-line benefits associated with growth. Overcoming barriers and achieving success with outsourced ASC billing In today's highly competitive environment, ASCs must find ways to navigate obstacles that stand in the way of viability and profitability. They must also pursue improvement opportunities that strengthen operations and financial performance. Outsourced ASC billing represents a time-tested service that delivers center-wide benefits, putting surgery centers in an even stronger position to achieve short- and long- term success. Surgical Notes is the premier ASC billing services partner. Our expert teams with ASC-specific experience provide scalable revenue cycle management services and solutions that fully integrate with leading ASC practice management systems. The largest management companies and hundreds of ASCs that partner with Surgical Notes benefit from immediate financial improvements.

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