How technology can improve ASC billing reimbursement as healthcare dives into value-based care

Technology has paved the way for more procedures to transition into the outpatient arena, and the growth of ambulatory surgery centers has surged in the last several years. With the additional business, surgery centers can accumulate more revenue.

"The evolution of value-based care will benefit ASCs in a meaningful way. If payers begin to see cost savings and better surgical outcomes when services are performed in an ASC setting, ASCs should see an increase in volume. It is also getting easier for surgery centers to dive into their data which allows them to make better decisions as it relates to the type of cases they are bringing in. Today, with the ability to tailor data with established technologies, surgery centers are expected to know their numbers and results," says Lindsay Joseph, executive vice president of operations for National Medical Billing Services.

National Medical Billing Services uses its expertise to build best practices in all aspects of the revenue cycle in order to help centers succeed financially.

"Payers are very sophisticated in being able to hold onto their money and find reasons to deny claims," says Nader Samii, CEO of National Medical Billing Services "Even when you crack the code, that code will change. You have to stay cutting edge with your strategy."

"We have an enormous advantage in that we work with more than 200 centers across 40 states," says Mr. Samii. "We see every strategy from every payer. We know what has worked and what the broader issues are."

National Medical Billing Services consults with ASCs and payers to identify cases that can be migrated from hospital outpatient departments to ASCs.  In addition, National Medical Billing Services helps to ensure that services provided by ASCs are getting reimbursed fairly.

"We arm our facilities with information on trending denials and assist them with creating better efficiencies to prevent future delayed or missed revenue," Ms. Joseph says. "We do a lot of research as it pertains to specialty, payer and region and structure our appeals accordingly. National Medical Billing Services digs very deep to find out how to best overturn underpaid plans."

The push toward value-based care will likely fare well for surgery centers, who can often perform procedures in a more cost-effective manner than their hospital counterparts. To thrive in the evolving marketplace, Ms. Joseph advises surgery center leaders to pay close attention to the market and which procedures are trending toward the outpatient setting, or newly approved procedures, with great outcomes, in an outpatient setting. For instance, in 2015, nine spine procedure codes were added to the Medicare approved list and in 2016, a few category three spine codes were added in addition to nine gynecological codes.  

"You should always be aware of changes in the industry and how it could impact your surgery center," she adds. "As surgery centers evolve, so should its leaders and everyone affiliated with the center."

Surgery centers should consider adding new service lines if resources allow and implementing technology that will improve their billing and collections processes. Having the right technology in place can help surgery centers prevent another major issue — cyberattacks. Although smaller than hospitals, hackers may also target surgery centers for patients' information.

"Few people are focused on an enormous threat to RCM and healthcare in general and that threat is cyberattacks," Mr. Samii says. "There is a whole world of this activity going on and every day there is another incident. We spend a lot of time, effort and money into thinking about ways to shrink this risk as close to zero as possible. This is an issue for big health systems and surgery centers, which are the easier target."

Surgery centers can use data to drive meaningful change, and protection of that data is crucial. Having the right systems in place for all of a center's operations will work to ensure the center thrives in the future.

"Centers have to take the time and resources to analyze the data at their fingertips. This is not easy as it requires a detailed understanding regarding which performance indicators drive which result," Mr. Samii says. "We live heavily in a world of data analytics and data is becoming king."



More articles on coding & billing:
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Wisconsin health officials ask to increase Medicaid spending by $452M: 3 things to know

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