Ambulatory surgery centers are power houses when it comes to clinical quality. From excellent patient outcomes to nearly nonexistent infection rates, ASCs excel, but does the business office side perform nearly as well?
Here are four core thoughts on evaluating and improving ASC revenue cycle management strategies.
1. The warning signs. Revenue cycle management is a complex process that touches every aspect of an ASC's operations, but there are number of apparent red flags that indicate the current strategy needs to be reevaluated. "A few warning signs that warrant further investigation include: a decrease in your revenue, increase in A/R days, an increase in upfront denials and contract variances," says April Sackos, vice president of revenue cycle management with Meridian Surgical Partners. High staff turnover can also indicate management issues.
2. Common stumbling blocks. ASCs do not have the resources of a hospital or health system; controlling all revenue cycle management processes with limited staff and resources is much akin to a delicate juggling act. Many surgery centers struggle with similar issues. Common stumbling blocks, according to Michael Orseno, director of Regent Revenue Cycle Management, include:
• Lack of necessary or quality IT
• Inappropriate management information system
• Shortage of useful reporting
• Dearth of knowledgeable staff
3. Key ways to improve. Despite these obstacles, surgery centers can improve and master revenue cycle management. "Make sure you have internal monitoring and benchmark key performance indicators," says Ms. Sackos. "[Consider] Automating benefit verification, payment posting, insurance follow-up and payment plan monitoring, to name a few."
New processes and consistent monitoring can go a long way to revamp an ASC's approach, but any of these changes are difficult to achieve with the wrong staff. Regent RCM has developed assessments for both staff- and management-level business office candidates. These assessments are designed to test practical knowledge and identify candidates who will excel in an ASC environment. Consider integrating such an assessment into your surgery center's business office hiring process. “If your ASC's area has a shallow talent pool, outsourcing is always an option,” says Mr. Orseno.
4. In-house vs. outsourcing. In-house and outsourced revenue cycle strategies come with a set of unique challenges. "In-house challenges typically stem from finding and retaining the right staff with the knowledge, and expertise required to successfully manage the revenue cycle functions," says Ms. Sackos.
On the other hand, completely outsourcing presents a communication challenge. If there is a simple question or a larger issue, it isn't simply an issue of walking down the hall to the business office. Outsourcing also makes it easier to lose touch with financial data and revenue cycle processes. "ASC leaders may not invest time to find a problem; they may just blame the vendor," says Mr. Orseno. "The consequence of which they unfamiliar with their own data."
"Regardless of whether you outsource or perform all functions in-house, it is a team approach," says Ms. Sackos.