If your ASC can pay its bills on time, make regular distributions to its owners, and afford the occasional capital investment that helps drive growth, congratulations! Many ASCs struggle to accomplish one or more of these indicators of financial stability and success.
And yet your ASC may not be achieving its full financial potential. That's why it is important to consider the value of outsourcing your revenue cycle management (RCM) operations. It's a practical business decision that more ASCs are pursuing. By partnering with a company possessing extensive surgery center RCM experience and resources, ASCs get paid what they are owed in a timely, efficient manner. Collections increase while denials and bad debt decrease. With margins tightening, that's critical. Even successful surgery centers cannot afford to leave money on the table that they rightfully earn.
But that's not the only reason to consider outsourcing your RCM. ASCs are discovering that there are many other perks beyond getting paid that come with turning over management of their revenue cycle to experts. Here are six of the most significant benefits.
1. True evaluation of performance. It's one thing to think your ASC's business is performing well. It's another thing to know it. RCM companies will typically perform a comprehensive assessment of an ASC's business performance at the beginning of a partnership (or sometimes before a partnership is finalized, if such a service is offered). This evaluation dives deep into an ASC's operations through auditing accounts, examining existing processes, and calculating metrics. The goals of the assessment are to paint a detailed picture of an ASC's performance that relies solely upon facts and figures and provide a roadmap for improvements.
RCM companies will perform such assessments on an ongoing basis to determine whether changes are having their desired effects, identify new opportunities for improvement, and catch potential problems early. Areas of your ASC's revenue cycle likely to receive scrutiny include accounts receivable (A/R) days, coding, operative notes, payment posting, charge entry, claims submission, claims and denial follow-up, rebills, charge lag, credit balances, and self-pay balances.
2. Accommodate volume changes. Expecting a substantial change to your ASC's volume in the future? An important advantage of partnering with an RCM company is its ability to adjust the level of support to account for changes in volume. Whether you add a specialty, physicians, and/or procedures, the company will allocate personnel and resources to ensure your growing revenue cycle needs are addressed. If you lose a physician or need to scale back operations for another reason, the company will modify its support accordingly. Does your volume swing from month to month or season to season? The RCM company can adapt to these changes as well. You will spend less time addressing revenue cycle and associated staffing needs and have more time to tackle other aspects of your operations affected by shifts in volume.
3. Reduce staffing costs. When there's less RCM work to be performed in-house, ASCs can reevaluate their staffing model and determine what opportunities exist to cut costs. One option ASCs can consider is reducing its total business office staff, which delivers immediate savings. Some surgery centers that outsource their RCM choose to keep their existing business office staff but reassign responsibilities to complete the remaining internal RCM tasks more efficiently. More available staff time can help surgery centers reduce expenses associated with overtime and per diem staff brought in when employees take time off. If the surgery center is experiencing growth, there may not be a need to hire new staff to accommodate an expanded workload.
4.Unexpected staff developments. If a member of your business office staff came to you today and said he or she found a new job, was retiring, had been diagnosed with a serious illness, or wanted to take a two-week vacation, how would you respond? Do you have enough staff to cover a short absence? How about a long absence? How easily could you find a qualified new staff member to fill an opening? How much would it cost to recruit and train a new employee?
If your ASC is like most centers, you maintain a lean staffing model and may dread any news that would require a significant change to your staff schedule. By partnering with an RCM company, some of this stress will be alleviated since you will no longer need to worry about staffing for those responsibilities handled by the RCM company. The company will be tasked with ensuring your ASC always has the revenue cycle support necessary to address your billing needs.
5. Ongoing education and training. Coding and billing rules undergo frequent changes. This is true for federal and private payers. Federal and state laws affecting payments also experience regular revisions. Keeping up with these changes can prove difficult, especially as your number of payers increase. Miss a rule or law change and it could lead to denials and delayed payments. Determining the cause can prove challenging. When you do learn of a rule or law change, you need to allocate time to educate and train staff and ensure they understand how to properly code and bill according to updated requirements.
These responsibilities are no longer yours when you partner with an RCM company. Its team must ensure the professionals assigned to your account understand the rules and laws your ASC needs to meet to get paid correctly and promptly. RCM companies typically have effective means of monitoring announcements from payers and regulators and identifying the critical, pertinent information included in these announcements that will affect their clients' businesses.
6. Experts driving your business. A considerable challenge ASCs face — particularly those in rural areas — is recruiting and retaining qualified team members. Even surgery centers in urban areas can struggle to attract and keep skilled employees because of increased competition for and scarcity of these individuals. An inability to add competent team members can lead to extended job openings or settling for a hire that may lack the skills needed to excel in his or her position.
When you partner with an RCM company, the team members assigned to your account should be experts in their field, knowledgeable in ASC coding, billing, and other revenue cycle functions. ASC RCM companies focus their recruitment efforts solely on finding and developing surgery center revenue cycle experts. If the company is based in a major, urban market, its pool of candidates will be much larger than that of an ASC in a rural market. If the company employs remote staff, the candidate pool will grow significantly, helping ensure the team member supporting your ASC have been vetted extensively and are qualified to manage and support your account.
Due Diligence is Essential
The benefits discussed above are not necessarily guaranteed with all RCM companies. Conduct research on those companies you are considering before choosing a partner. Make sure companies are experts in the ASC revenue cycle, specifically the types of specialties provided by your center. Ask how they keep their team members current on rules and regulations. Find out what methods they use to keep your financial and patient data protected. Speak with references. If you plan to attend state and/or national ASC conferences and companies you are considering will be exhibitors at these events, arrange on-site meetings to learn more about the companies and their services in a face-to-face discussion. By performing meticulous due diligence, you can better ensure the RCM company you select will be the right partner for your ASC for years to come.
Angela Mattioda (firstname.lastname@example.org) is vice president of revenue cycle management services for Surgical Notes RCM. Surgical Notes is a nationwide provider of revenue cycle solutions, including, transcription, coding, revenue cycle management (RCM), and document management applications for the ASC and surgical hospital markets. Mattioda oversees the SNBilling RCM service, the newest component of Surgical Notes' complete end-to-end revenue cycle solution offering.