Surgery centers have different methods for dealing with processes on the business end, which includes revenue cycle management and patient collections. Some ASC owners prefer to keep business operations in-house, while others prefer contracting with a company. There are benefits and drawbacks of each.
In-house business services
Central Maine Orthopaedics' ASC has always had an in-house business office, which includes around eight employees. According to Jan Fournier, CFO, an in-house business office is the most cost-effective option for them.
"We have done a cost analysis and [outsourcing business services] would be more expensive. And I think we do it better. Our performance benchmarks exceed national averages and we are better able to meet our patients' needs," she says.
The ASC's billing department uses a tool to analyze cases by CPT code and determine how much each case would cost. The business office only authorizes procedures to be performed after cost and reimbursement is determined. The office helps the ASC meet the growing demand for price transparency by communicating out-of-pocket costs to all patients prior to surgery.
Also, after each surgery, and prior to billing, an ASC staff member, usually the scrub tech will review each chart to ensure that all costs have been captured. "The reason we have the scrub tech do it is because they are most knowledgeable regarding the specifics of each type of surgical case," adds Ms. Fournier.
At Central Maine Orthopaedics ASC, the business office has responsibilities beyond revenue cycle management. The billing and payments process is interactive and involves every department, from the front office to the clinical staff. "With in-house billing, we can walk down the hall to our physicians and clinical staff for coding and documentation clarification. Everyone is vested in the success of the process," says Ms. Fournier. " I am not sure that we would see the same amount dedication and concern from a third-party [billing company]."
Additionally, the in-housing business office allows Central Maine Orthopaedics to develop and maintain patient relationships. Once the business office has conducted a cost anaylsis and authorized the procedure it notifies the patient about the out-of-pocket expenses.
"This initial communication is the starting point for the development of a relationship between the patient and the business office. We also use this opportunity to establish payment expectations and payment arrangements prior to surgery," she adds. "We have people dedicated to working with patients who have out-of-pocket expenses. This personal service would be difficult with a billing company. Our goal is to establish, then maintain that relationship over the entire episode of care, right up to the final collections."
An onsite billing department can also answer patient questions immediately, which they appreciate, notes Nicole Smith, the clinic manager.
Outsourced business services
Ambulatory Surgery Center of Stevens Point (Wis.) made the decision to outsource business office operations in 2008 and has not looked back since.
The ASC had been experiencing an increase in its accounts receivable on a monthly basis and was having issues with denials. "At one point we were close to 100 days," says ASC Administrator Becky Ziegler-Otis. "We were expecting the same billing staff who were taking care of the adjacent orthopedic physician practice to handle the ASC billing since the majority of our cases were orthopedic."
However, orthopedic practice billing and ASC billing are not the same, Ms. Ziegler-Otis quickly learned. She considered hiring staff for the ASC billing specifically, but was not able to find employees with the specific expertise in her relatively small community. "Additionally, we were concerned that if we did find the expertise and hired internally, how would we handle time-off of the employee to avoid a backlog in billing? And if there is turnover, re-training new staff members would have also resulted in backlog, which affects the bottom line," Ms. Ziegler-Otis says.
Internal staff in a small center like Ambulatory Surgery Center of Stevens Point would most likely be pulled to assist with other activities as needed. It's also difficult for one person in-house to stay abreast of rapidly-changing billing policies and government regulations.
A third-party company can offer expertise and best practice strategies for billing and handling denials. They can assist with understanding billing policies and look for trends and patterns with regard to payer-specific denials.
In 2008, the ASC settled on signing a contract with SourceMedical Revenue Cycle Solutions.
"For us it was the right decision and we continue to remain satisfied with our decision," says Ms. Ziegler-Otis. "Our satisfaction is based upon the status of our accounts receivable information such as days in A/R, percentage of A/R in 0 to 60 days and percentage of A/R in more than 90 days as well as lack of complaints from our patients."
It is important that the center has consistent communication with the company to assist with difficult self-pay clients or payers. Once that relationship is established, the outsourced company can feel like an extension of the center.
"We really want our patients to feel like when they call the billing company, they are calling the surgical center and they are treated in the manner in which we treat our patients," says Ms. Ziegler-Otis.