Issue link: https://beckershealthcare.uberflip.com/i/1539853
Maximizing ASC Financial Performance Through Unified Revenue Integrity By By Elaine Dunn, Chief Administrative Officer, GM Strategic Solutions and Jessica Thurston, VP, Client Development at nimble solutions A mbulatory Surgery Centers (ASCs) operate in an environment defined by high surgical volumes, shrinking margins, and increasingly complex payer demands. In this landscape, fragmented revenue cycle workflows don't just create inefficiencies— they open the door to avoidable denials, cash flow delays, and long- term revenue leakage. e path forward? A unified revenue integrity strategy—one that brings together documentation, coding, billing, and payer strategy into a seamless system. is kind of alignment doesn't just streamline operations—it prevents leakage, boosts reimbursement accuracy, and empowers ASCs to make smarter decisions faster. Strengthening Front-End Clearance to Prevent Costly Denials Revenue integrity doesn't start with billing— in fact, it starts well before the first incision. at means getting the basics right: accurate demographic capture, real-time eligibility verification, thorough benefits checks, and airtight prior authorization workflows. ese steps ensure services are medically necessary and ultimately reimbursable. Incomplete or incorrect data oen leads to denials and delays in cash. Authorization-related front-end denials consistently rank among the top denial reasons, with a recent study showing that they account for 9% of all claim denials. Oen, a procedure is scheduled and authorized, but a different procedure is indicated and performed during the surgical encounter. Securing range-based authorizations for procedures that may change during care, along with reviewing coded procedures against authorized services, ensures charge accuracy and reduces the risk of retrospective authorization issues. Building CDI and Coding Excellence for ASC Profitability At the core of revenue integrity is Clinical Documentation Integrity (CDI), which ensures that patient records accurately reflect the care provided. Clear, timely, and procedure-specific documentation serves as the foundation for correct code assignment, appropriate modifier use, and compliant surgery center billing. You should consistently achieve a 95% CPT and ICD coding accuracy rate, reinforced by payer-specific guidelines and specialty-aligned expertise, to minimize denials and ensure compliance. Clean claim submissions demand rigorous adherence to payer-specific requirements for implants, modifiers, and revenue codes. Following generic coding guidelines isn't enough—embedding authoritative sources like AMA/AHA references, payer bulletins, and contract terms into SOPs improves consistency and boosts claim acceptance. Quick Wins for ASCs: • Conduct quarterly coding audits to ensure ≥95% accuracy • Integrate payer policy updates into monthly coder training • Review authorization workflows weekly to avoid front-end denials Breaking Operational Silos: e Case for a Unified RCM Strategy ASCs oen create operational silos that hinder claim reconciliation when their revenue cycle is split between in-house teams and outsourced vendors. ese disconnects can result in mismatched claims, denials, delayed reimbursements, and reduced payments. Implementing holistic solutions that support a unified RCM strategy helps eliminate these gaps by enabling end-to-end visibility, continuity, accountability, and faster resolution across the revenue cycle. Inefficient revenue integrity processes can delay cash by increasing the time it takes to submit clean claims to payers. An ASC's days- to-bill target should be 3 days; longer timelines should be closely reviewed to identify breakdowns in core revenue integrity processes, support timely and accurate reimbursements, and enable precise case costing to drive profitability. e Value of RCM Technology and Analytics in Surgical Care Compounding the challenge is limited RCM support in many ASCs; without proactive system management and routine updates to key tables, even strong workflows risk billing errors, underpayments, inappropriate write-offs, and audit exposure. Robust analytics support broader financial visibility, such as case costing and cash per case, which offer a clear view of payment velocity and reimbursement accuracy, and reveal how effective documentation, coding, and charge capture translate into actual revenue. Want to make smarter financial decisions? Start by asking: • Which procedures deliver the highest or lowest cash per case— and why? • Where are we losing margin due to coding gaps, incomplete authorizations, or low-value contracts? • What steps can we take to optimize revenue across our highest- volume service lines? Bottom Line Billing fast isn't enough. Sustainable financial performance in surgical care demands a proactive, unified approach to revenue integrity— one that integrates people, processes, and technology across the case lifecycle. ASCs that embrace this model aren't just reducing denials or cleaning up coding—they're maximizing revenue per case, protecting long- term margins, and freeing up staff to focus on what matters most: delivering exceptional patient care. n