Becker's ASC Review

20 ASC Turnarounds b. If possible, talk with clients of the outsource companies you are con- sidering to determine their level of satisfaction. c. Determine the experience and knowledge level of the staff who will be working your account. Do they have certified GI coders? Will coders review denials and appeal when appropriate? d. Do they collect self-pay balances? e. What technology do they bring to the practice to collect more infor- mation that can be used to collect more money? f. Will the staff be dedicated to your account, or will they be servic- ing other clients as well? Calculate actual onsite visits versus relying solely on weekly conference calls between the practice manager. g. Compare costs of all outsource companies under consideration, taking into account the service model of each. If a hybrid model is involved, account for the internal costs of the staff you will need in-house. h. Compare the costs of outsourcing to the cost to keep in-house, tak- ing into consideration all direct and indirect costs. 3. In-house billing allows for more direct control and accountability. If you outsource, it is advisable to have someone in your practice (or an external adviser) who is knowledgeable enough to monitor the out- source vendor and hold them accountable. Performance expectations should be established and performance clauses in place in the contract. The vendor must be responsive and put your interests first rather than at the end of a long line of other customers who may be more profit- able to them (such as hospital systems). BT: I prefer in-house because I feel there is more accountability and direct responsibility if the practice manager directly manages the business office functions. Outsourcing business office and revenue cycle functions may be a better fit for smaller (less than five physician) practices. When the practice manager oversees the business office and recycle management functions, you can gain some efficiencies by cross training staff between the front desk and the business office, for example. The benefit to cross-training can be that the front office staff member now understands how many additional steps can be involved if the referral is not gained in a timely manner, or if the patient has to be billed for their $15 co-pay. Q: What are the biggest revenue cycle management challenges GI practices and endoscopy centers face in 2015? LG: Changes in payment paradigms and elimination of SGR payment sched- ules creates a great unknown. Having cash reserves or access to credit lines may be necessary for many practices. MM: The biggest challenges for 2015 include: • Assuring that payers are not denying claims inappropriately • Assuring that payers pay according to your contracts • Gaining assistance from payers to resolve unpaid claim issues • Collecting from individuals with high deductible plans or co-insurance requirements • Assuring that claims are "clean" and have the lowest possible chance of being rejected based on errors • Implementing ICD-10 and minimizing any related cash flow issues • Following payer-specific coding requirements related to the temporary GI codes in place for 2015 • Planning for expected RVU revisions for lower endoscopy codes in 2016 BT: ICD-10 will be biggest challenge that GI groups face in 2015, along with the possible reduction in RVU values for the lower endoscopy codes. Each group will need to determine how to implement ICD-10 to assure that they do not face an increase in denials, or a lag in payments. Groups should look at their entire business operations to determine if they can decrease costs and improve revenue (increased productivity or better rates on com- mercial contracts). As they say, "every nook and cranny" will need to be reviewed to determine where expenses can be cut and additional business can be gained. Q: What are the biggest opportunities to improve revenue cycle management this year? LG: The biggest opportunities are, for practices accepting insurance, opti- mizing the new pay for performance rules as they roll out. Many practices will continue to look at alternative private pay or concierge practices to main- tain financial stability. MM: The biggest opportunities include: • Upfront collection of co-pays, deductibles, and co-insurance • Improving your "clean" claims rate • Strict performance clauses if your billing is outsourced • Review of payments and denials closely, especially for claims with mul- tiple surgery codes • Compare payments to contracted rates • Persistence with payers to resolve claim issues • Solid position descriptions for all employed workers in the practice so that they are held accountable for collecting monies, gathering data to be used in the collection process BT: Collect deposits upfront and determine if you are leveraging IT to the best of your ability. For example, assure that you have collected a deposit that is equal to or greater than your cost of providing the endoscopy service. Next, give patients the ability to pay their bills online or via electronic statements. Many of the online payment systems allow patients to develop their own pay- ments plans, within your guidelines (i.e. no more than three payments and not less than $50). By having the patient set up their payment plans, the GI staff do not need to be involved and their time can be spent on more difficult patient account collection calls or processes. n SAVE THE DATE learn more & register at https://www.regonline.com/22ndAnnualASC October 22 - 24, 2015 Swissôtel - Chicago, Illinois Becker's ASC 22nd Annual Meeting The Business and Operations of ASCs 51 Great Surgeons, 55 Leading Administrators and 110 Surgery Center Speakers in Total

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