The ABCs of an Effective ASC
Zawna Health, and Rachel Fields, editor-in-chief of Becker's ASC Review.
Running a surgery center means wearing a variety of "hats" to oversee billing, patient care, development, physician and staff satisfaction and strategic direction. Here, Zawna Health outlines an "A-Z" guide for surgery center success.
Accounts receivable: Accounts receivable is the lifeline to a center's future. Without revenue, a center cannot operate. The longer a claim is sitting with an insurance company, the harder it is to collect. ASCs should closely monitor their days in A/R to ensure revenue is not needlessly sitting at the insurance company. They should also set days in A/R goal to continually work towards.
Benchmarking: Benchmarking is important for any business, including ASCs. ASCs need to look at other ASCs, as well as hospitals in their area, to see how they measure up. Looking at other ASCs and seeing what is working well for them can give you a new perspective of how to improve your ASC. One of the benefits of ASCs is the cost-savings compared to hospitals. Looking at the costs of outpatient procedures at a hospital and comparing them to the cost-savings available through the ASC is a great marketing tactic.
Coding: Certified and knowledgeable coders are a must-have in an ASC. Since most ASCs only get paid for procedures, coders must confirm they have coded all procedures correctly. If a coder misses one thing, the ASC can lose a lot of profit. Even though ICD-10 implementation has been pushed back to October 2014, doesn’t mean coders should push back their training. Coders should begin preparing for ICD-10 today.
Document, document, document! This cannot be stressed enough. Documentation is one of the most important aspects of billing for an ASC. If a physician or medical assistant misses a documentation item, it can mean a loss of profit for the center. If missed documentation is something that occurs often, the ASC can be losing a vast amount of revenue.
Equipment inspection: Equipment inspections should occur regularly. Faulty equipment can be detrimental to the center and jeopardize patient safety. Make sure staff is trained on how to correctly use the equipment, and keep a log of any repairs or issues that have arisen with each major piece of equipment.
Follow-up: Follow-up is an extremely important aspect of billing. Insurance companies are constantly requesting documents before processing claims, and more often than not, it seems the center never receives the document request. If follow-up on claims is never done — or done very little — you'll never get paid half of what is billed out. If revenues are a little low, try beefing up follow-up and see how much more revenue comes in.
Garbage-in, garbage-out: Having accurate and up-to-date patient information is vital. If the registration information is wrong (i.e. garbage), it can cause claims to be denied or delay payment. It causes a big headache and can cause a loss of revenue from reallocating resources to fix the "garbage" problem.
Healthy work environment: Disturbing behaviors among staff can be detrimental not only to the ASC but also to patients. There are so many differing personalities among workers that often ASC leadership accepts the inevitability of interpersonal issues. Leaving these issues unchecked can cause them to escalate into full-blown crises. The quickest way to advert the crises is by addressing the issue at hand. If the problem stems from the workplace, a solution should be found quickly to ensure staff satisfaction. If the problem is a personal conflict among staff members, they need to be notified that this issue will no longer be tolerated within the workplace. An ASC should consider adopting a zero-tolerance policy in order to pre-empt interpersonal issues or implement the same consequences for each employee if disruptive behavior occurs.
Inventory management: Managing inventory is a "must-do" in an ASC. Two common problems with mismanaging inventory are either having too much inventory on hand or not having enough inventory. If you have too much inventory, it can drain profits. Inventory that has a shelf life can expire, and then you are throwing away money. On the other hand, not ordering enough inventory can also cause a huge problem. The center cannot provide exceptional patient care if staff members are running around trying to find the correct supplies for a procedure. An ASC should designate an employee to research the inventory turnover rate and determine how much inventory to have on hand and the optimal reorder time. They should also rotate inventory, so the oldest is being used first and no inventory is being thrown away due to expiration.
Justify your decisions: ASC leaders often make decisions that can change and impact how the staff operates. While it is the administration's right to make these decisions, staff may resist the changes if they do not agree with or do not understand the decisions being made. By simply explaining that "change A" is being made for the betterment of the center, you are more likely to gain staff support and implement the change easily. When the staff feels like they are a vital part of a facility they will work harder to make the facility better and the patients happier.
Know what the future holds: The healthcare industry is constantly changing, especially as the ICD-10 deadline looms and healthcare reform dominates conversation. The best thing to do for your ASC is to study about any potential changes that can affect the center. The best defense is always a good offense. You don’t want to procrastinate and have to figure out how to implement new rules and regulations at the last minute.
Luncheons: An informal luncheon with physicians and administration is a great way to show ASC staff you appreciate them and to build relationships. According to a recent Forbes article, happy employees are 50 percent more motivated than their unhappier counterparts. Also, happier employees focus 80 percent of their attention on their jobs, while unhappy employees focused on their jobs only 40 percent of the time.
Modifiers: Always check your modifiers. Forgetting to add modifiers or using incorrect modifiers is one of the quickest ways to get a claim denied.
Negotiate contracts: Research other ASCs and hospitals in the area so that you can present information on payment rates during your payor contract negotiation. If payor contracting isn't your forte, look into hiring a company that specializes in contracting with insurance payors.
Open communication: Open communication and good relationships with other physicians are extremely important. Patients appreciate knowing their primary care physician (or the specialist that referred them) is "in the loop" about their procedure. It makes the patient feel more confident in the physician and staff and leads to a better reputation for the center.
Patient satisfaction survey: Patients who have had a negative experience at an ASC are likely to let their friends, family and physician know about the incident. Too many negative reviews can harm the center's bottom line. Rather than letting the patient vent to the community, give them an outlet to voice their concerns. Send out patient satisfaction surveys and encourage patients to be honest. Patients may point out easily fixable problems the physicians or administration may not have noticed.
Quality control: Quality control measures are going to continue to get stricter in the face of the new healthcare reform regulations. As of October 1, 2012, CMS certified ASCs now have to report quality measures or face a payment penalty. This can be positive for ASCs because it can show they measure up with hospitals and can be a step towards increased reimbursement rates. One step for insuring quality control is for an ASC to implement safe surgery check lists which ensure the physicians and staff are adhering to the center’s standards.
Reach out to increase referral sources. There are two ways to increase revenue in ASCs. One way is to increase the cost of procedures. This is often hard to do without intense negotiations with insurance carriers on increasing allowable amounts. The other way is to increase the ASC volume load, which is generally easier than increasing payment rates. Increasing volume involves reaching out to primary care physicians and specialists and building relationships in order to increase their referrals to the ASC.
Scheduling: An efficient surgery schedule is the foundation for a productive ASC. An ineffective surgery schedule can wreak havoc on physician, staff and patient satisfaction. Review your current scheduling processes and look for opportunities to make better use of the procedure rooms, as well as physician and staff time.
Transcription: When it comes to billing, the focus is often on getting the charges in the system and out the door to the insurance company. The transcription department can be under a lot of pressure to transcribe as quickly as possible to move the process along. However, they need to be careful not to miss any pertinent information, which can ultimately lead to a loss of revenue for the center.
Utilize ASC associations: There are many organizations and associations dedicated to representing and furthering ASCs. Take advantage of these organizations, as they can offer expert advice on all topics relating to ASCs. They also advocate for surgery centers on the local and national level. Most associations have online forums to field your questions about administrative and clinical issues.
Verification: Insurance verification is extremely important before performing procedures. Procedures can be costly, and it's important to verify that the patient has insurance, as well as the details of his or her benefits. Most patients have no idea what their benefits are and may be surprised if they receive a big bill after a procedure. By researching the patient's benefits, you can explain what their costs will be prior to the procedure. This will save a lot of time on the back end, when the business office is trying to collect money from delinquent accounts.
Wait time minimization: Wait times drive patients crazy. They believe that when they make an appointment, they should be able to see the physician at that time. However, patients do not understand that unexpected delays can lengthen ASC waiting times. An ASC should strive to minimize patient wait times by making sure staff and physicians are prepared ahead of time.
eXcellence: Expect excellence from your staff and physicians when it comes to patient care. Setting expectations helps the center track its progress and helps the staff understand the leadership's expectations
You should continue to find ways to improve: The saying, "It is better to drink from a flowing stream than a stagnant pond" is true in life as well as for ASCs. The moment an ASC stops moving forward, it starts to die. While this may seem a little extreme, it is certainly true. In this day and age, technological developments are dictating which surgical facilities will pull ahead of the pack. By continually looking forward and examining opportunities for expansion, your ASC will stay ahead of the competition.
Zero infection rate: All ASCs should aim for a zero infection rate among their patients. The Center for Disease Control and Prevention recently did a study that found two-thirds of ASCs had at least one lapse in infection control. Slips in control issues can be detrimental to a patient's health and the facility's reputation. ASCs should strictly follow health and safety standards, provide training programs for staff, and conduct regular audits to make sure they are meeting standards. CMS is providing an ASC Infection Control Audit tool that can be found on their website.
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