Should Your ASC Outsource Coding And Billing?

In today's economy, why should you consider spending additional money to give your most precious asset to an outsider? Before you determine that outsourcing your ASC's coding and billing is not for you, take a moment to read more about it. You can then make an informed decision on whether outsourcing might be the right choice for your center.

If you are planning to build an ASC, evaluate outsourcing your billing while you are still in the design phase. You may be able to save on square footage and the amount of business office employees needed. Even if you are already building your surgery center, look at how you might be able to reassign some of the business office area into revenue-generating clinical space.

In existing surgery centers, the idea of outsourcing is often met with resistance by physician-owners and administrators who feel that outsourcing billing is not a positive choice. Thoughts on this include:

  • "My billing staff is doing a good job!"
  • "Costs too much!"
  • "I need to be in control!"
  • "Change is BAD!"

If you have a great coding and billing staff, count your lucky stars and ignore this article.

However, if you feel your coding and billing are less than stellar, you may want to consider the following when evaluating how to improve your center's financial performance. There are several reasons why your ASC may not be collecting all that that it can.

  • Lack of experienced coding may lead to leaving fees on the table. This is not about unbundling or fraud; this is about being able to interpret the operative note and charge for all allowable procedures while remaining compliant.
  • What about implants? Are they being billed properly and collected fully? With today's cost of implants and the frequent use of multiple implants during a procedure, it is imperative that your billing staff understand the types of implants and when and where they are used. Operative notes are not always specific and there may be additional implants used that are not listed — this may require a surgeon's addendum to the operative note.
  • Does your staff understand that you are able to charge additional fees for handling and shipping in addition to the cost of the implant?
  • If your center has ophthalmology, is the full invoice amount for the shipping and handling of corneas from the eye bank being included?

Now let's dispel the "costs too much" myth. If a billing company charges you five percent of collections and you can eliminate the following expenses, which do you think is more cost-saving?

  • Depending on the size of your center and the amount of business office employees, determine what salaries could be eliminated if your billing was done off-site.
  • Take into account other expenses that would decrease such as employee benefits, computers, furniture, supplies, clearinghouse fees, postage for statements and business office space (maybe you can convert some of the regained space into clinical space).
  • What if you could increase your gross revenue by 5 percent? How much more money would that mean in your profit bucket?
  • What if you could decrease your days in A/R by 5 days? What does that mean to your bottom line?
  • How about the immeasurable savings?

           - No patient phone calls about statements.

           - Chasing your denials to the highest level of adjudication (does your current collector do that?).

           - Doing lengthy deposits and taking them to the bank.

Next, let's discuss the control issue. If you are the one having to answer to the board, it is only natural that you want to control your own destiny. However, a good billing company allows you to be involved and in control — you just don't have to do the day-to-day work. If a billing company is accessing your ASC's software via an encrypted network, then you have real-time access to all of their work 24/7. All reports are current. If you have questions — they are only an e-mail or phone call away. It's just like looking over their shoulder electronically. Also, there should be regular communication, like weekly reports and phone calls and daily communication with your staff from a dedicated team-leader and liaison for your center.

Change does not have to be BAD. If even one of the following reasons apply or appeal to you, it may help you in rethinking your ideas on outsourcing.

  • A lot of surgery centers cannot afford or do not have access to certified and experienced coding and billing staff. A billing company's staff is their major investment, they work to attract the best and the brightest and pay them top salaries in order to ensure optimization, accuracy and compliance. These are the people that will be working for your center.
  • If your surgery center has ever had a key member of its coding or billing staff leave (even temporarily for illness or vacation), you understand the disruption that occurs. Coding/billing does not get done regularly, if at all. Revenue dips, and owners become upset. Billing companies have employees and supervisors who are able to fill in for sick or vacationing staff and your center will not even notice a slight hiccup.
  • In today's climate of increased and ever-changing HIPAA and compliance regulations, peace of mind comes from knowing that your billing company is up-to-date and processing your coding and billing with a focus on optimizing your revenue while keeping your center compliant.

We've all heard horror tales about billing companies gone wrong, especially those involved in practice management in the 80s and 90s. However, contrary to what you may have heard about billing companies, they are not all alike. That's why it's so important that you know what to look for when researching companies for outsourcing.

Know what you need to look for:

  • Reputation
  • Longevity
  • References from industry leaders or associations
  • Client references
  • Employees bonded
  • E&O insurance
  • Experience in billing for your ASC's specialties
  • Staff qualifications
  • Compliance and HIPAA plans
  • Red Flag policy
  • Coding and billing policies/procedures
  • Disaster plan
  • Protection of your data
  • HIPAA-compliant secure connectivity
  • Auditing program
  • Specializes in ASCs
  • Understands APCs
  • Understands managed care contracts

Reputable billing companies welcome the chance to show you how they are run, what they offer and why they are the best company to choose. Ask them to provide you with a list of services. Besides addressing these expected tasks:

  • coding by a certified coder;
  • claims submitted within 24-48 hours after receipt of necessary billing information;
  • oversight of claims processing through the clearinghouse and verification of receipt by payor;
  • collection activity begins within 15 days of submission and continues regularly thereafter;
  • payment posting done within 24 hours of receipt of payment; and
  • denials for no payment or underpayment started immediately…

… do they also:

  • assist center with fee schedule development or changes;
  • educate center regarding upcoming changes, i.e., CMS reimbursement;
  • advise center when managed care contracts may need to be renegotiated;
  • provide special reports when needed;
  • do state reporting where required;
  • provide duplicate off-site storage of data in case of disaster; and
  • have experienced IT staff?

Be sure to do your homework thoroughly before making a final decision. Consider visiting the billing company offices — you can learn a lot about a company by meeting the staff.

Just don't overlook all of the advantages of off-site billing. In today's digital world, your off-site coders and billers are only a keyboard-click away.

Learn more about Serbin Surgery Center Billing.

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