Becker's ASC Review

18 ASC TURNAROUNDS What is your ASC's Operational Strategy for Delivering Excellence and Getting Paid for it? As Q1 2018 comes to an end, the time is right for an operational check-up By Lindsay Miller, EVP at National Medical Billing Services Y ou have closed out your financials for 2017 and you probably set new goals to optimize your ambulatory surgery center (ASC) financials in 2018. A few months later, when the quarter draws to a close, it is time to assess how well your ambulatory surgery center is doing with respect to the new and improved mission. To check your progress, it's important to review the entire operation from the patient experience to the claim being paid correctly, and everything in between to make sure that your organization is on the right track. Starting with an operational audit can shed light on whether your ASC is moving toward achieving its goals or if there are problems impeding your progress. More specifically, to ensure your ASC is moving in the right direction, take time to: • Review operational flow from beginning to end • Examine revenue cycle benchmarks and KPIs and how your ASC mea- sures up • Identify areas where there are opportunities for improvement • Set clear goals for every member of the ASC team • Make sure goals are communicated to staff and presented in an area that is clearly visible • Secure buy-in to organizational goals • Create an operation's wish list that prioritizes what's needed to succeed – technology, appropriate staffing, additional training, etc. Having an operational checklist ensures that your ASC is in a position to successfully deal with pending regulatory changes. For example, ASCs need to be ready to succeed under value-based care models, where providers will be paid based on the quality of care delivered, not merely the quantity of services delivered. More specifically, your organization should be ready to comply with the final 2018 ASC rule, which was released by the Centers for Medicare & Medicaid Services (CMS) in November of 2017. CMS also has introduced "patients over paperwork initiative," a process that evaluates and streamlines regulations with a goal to reduce unneces- sary administrative burden, increase efficiencies, and improve the patient experience. Specifically for ASCs, CMS is finalizing the removal of three ASC quality reporting measures for the CY 2019.Removal of these mea- sures would reduce maintenance costs and administrative burdens with a reduction of approximately 1,314 hours and a savings of $48,066 collec- tively for ASCs. Additionally, CMS is finalizing a removal of six hospital quality reporting measures. Removal of these measures would lead to a reduction of 457,490 hours and a savings of $16.7 million collectively for hospitals in the CY 2020. e focus is clear.It should be all about the patient and, therefore, ASCs need to pay close attention to their revenue cycle operations. Hours managing the revenue cycle should be aligned with achieving compli- ance with these federal programs, which are designed to improve patient outcomes and satisfaction. In addition, hours should also be spent ensur- ing that your organization is paid correctly for services performed. ASCs should also be on the lookout for any changes with procedures being added to the ASC covered procedure list. For CY 2018, CMS made the determination that total knee arthroplasty, partial hip arthroplasty, and total hip arthroplasty would not be added to the covered procedure list. CMS announced that it was going to allow for further discussion and additional feedback before determining if these procedures would be added to the ASC list in the future. ese changes could have a signifi- cant financial impact for surgery centers across the country. Fourteen revenue cycle specific checklist items While it's important to look at overall operations, ASCs need to pay particularly close attention to revenue cycle issues. To get started, leaders should make sure that someone is accountable for the following areas: #1: Contracts. Are your contracts easily accessible and organized with the most up to date changes and or amendments on file? Does your revenue cycle team understand the reimbursement for your managed care contracts for procedures performed in your ASC? Take into account the changes that payers are requiring as new payment models unfold and don't pass over the fine print. For example, it's especially important to ensure that bundled payments cover the cost of implants. ASCs oen unknowingly enter into contracts that do not pay them for implants and, therefore, lose money. #2: Chargemaster. What is your chargemaster set at and why? Are there any procedures where you are charging less than allowed amount under your managed care contract? When was the last time your chargemaster has been reviewed and/or changed? #3: Patient registration accuracy. What is your demographic error rate for your ASC? Obtaining the patient's correct insurance information and loading it accurately in your practice management system is vital to getting your claims out the door in the most efficient way. Is your ASC currently capturing all patient eligibility and applicable authorizations for each case? Are your patients aware of their out of pocket expense as it relates to services performed? #4: Payer guideline changes. Payers typically update their guidelines at the beginning of the second quarter. Changes can include anything from services once covered to those same services no longer being covered, authorization requirements, use of modifiers, procedure frequency, medical necessity, narrow network additions, etc. #5: Key performance indicators. Each department within the revenue cycle needs to know exactly what its goals are. erefore, you need to ensure that key performance indicators are in place and well understood by all staff members. Business intelligence and analytic tools can help provide insight to monitor performance and hold your team accountable. KPIs include days to bill, aging percentage over 90, days in AR, cash per case, charge per case, monthly case volume, monthly cash goals, payer and specialty mix, gross collection ratio, etc. #6: Coding compliance, changes, and accuracy. A variety of coding changes came to fruition in 2018. Examples include: changes to pass through codes for pain and ophthalmology procedures, such as Omidria and Nevro high frequency spinal cord stimulation generators, which were separately bill- able and payable, however, now have N1 status, which means that payment is packaged and no separate reimbursement is allowed. ere are a few ENT procedures that will have combo codes for 2018. For example, CPT code 31253 has been created and should be used instead of reporting both CPT31255 and

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