Short-staffed ASCs Can Ease the Burden of Prior Authorization and Do More With Less

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Ambulatory Surgical Centers (ASCs) do an exceptional job of collecting patient deductibles, co-pays, and other patient responsibilities due prior to performing procedures.

For most ASCs, however, these processes are highly manual and involve several touchpoints between staff, payers, and patients. As in all areas of the healthcare industry, staffing shortages have ASCs running especially lean. Recruitment of new front-office staff is challenging, due to higher paying opportunities and positions elsewhere that allow employees to work from home.

In the U.S., the average ASC is small. In 2020, the average ASC employed just 20.6 employees[i]. Having one or two open positions quickly becomes a significant burden on the rest of the team. While individually, front-office registration-related jobs at ASCs are not highly paid positions, (data from Indeed, Glassdoor, and Payscale suggest average hourly wages between $17 - $22, depending on location), staffing is the second highest expense, after facilities, for most ASCs. Employee salaries, wages, benefits, and taxes make up 27.5%, on average, of net revenue for U.S. ASCs.[ii] Any effort to increase wages or to fill open positions can have a significant impact on a surgery center’s financial position.

At the same time that ASCs are facing ongoing staff shortages, they continue to serve as critical back-up for the COVID-strained hospital system. Staffing challenges mean that managers and administrators are often splitting their time between their primary duties and front-office patient registration activities, such as insurance verification and prior authorization calls to payers. It is not just an issue of time either; the frustration of being on hold with a payer for a prior authorization, following up on insurance eligibility, or trying to find out the status of a claim takes a mental toll when staff is already spread too thin. At the Becker's ASC 27th Annual Meeting in October 2021, panelists shared that it takes front-office ASC staff four phone calls on average to reach patients and to gather all the required registration data, including insurance policy information. Each one of these touchpoints is costly and slowly erodes an ASC’s ability to be profitable.

Accounts receivable (AR) optimization technology can provide real relief to overburdened, frustrated staff members. According to research conducted by ZOLL® Data Services, automated solutions for insurance verification and insurance discovery, for example, can reduce staff’s administrative burden by up to 30 percent. A simple Medicare beneficiary identification number (MBI) lookup takes 2 minutes to perform manually, compared to less than 5 seconds using an automated tool. When a routine eligibility check comes back with coverage not found, insurance discovery tools can return the correct plan in seconds, eliminating the time to make multiple calls to the patient and or provider’s office to obtain the correct information. With the right technology, a staff member can review status of an active claim at the click of button, as well as see when payment is anticipated. There are also automation solutions for prior authorization that streamline previously tedious, manual processes and give ASC staff the bandwidth to focus on the higher-value responsibilities.

Myndshft, a prior authorization automation solution provider reports that,Depending on the complexity of the prior authorization request, the level of manual work involved, and the requirements stipulated by the payer, a prior authorization can take anywhere from one day to a month to process manually.” Indeed, the 2020 American Medical Association (AMA) Prior Authorization Physician Survey revealed that 85% of physicians describe the burden associated with prior authorization as high or extremely high.[iii] The delays and additional burdens caused by manual processes create problems for both patients and providers downstream. These can be avoided with a few best practices.

Best Practices To Reduce Front-end Staff Burnout and Optimize Accounts Receivable (AR):

1.    Review all front-end manual processes

2.    Solicit input from your staff to understand pain points

3.    Identify opportunities to leverage technology to reduce or eliminate administrative burden

4.    Evaluate and implement automated AR optimization solutions, including:

a.    Insurance verification

b.    Demographic verification

c.     Insurance discovery

d.    Prior authorization

e.    Claims monitoring

ASCs are cost-effective alternatives to hospitals for many types of surgeries, and the fact is that they have a much slimmer profit margin than hospital outpatient departments. Supply, equipment, and labor costs are rising, but insurance reimbursements are not. Manual administrative processes are both costly and unsustainable in the lean ASC environment. AR optimization technologies that automate and optimize the collection and management of patient and payer data contribute to healthy financial performance.  These solutions quickly pay for themselves by boosting the productivity of existing staff generating more revenue faster without increasing head count. At the same time, relieving staff of some of their more onerous administrative burdens can contribute to retaining good people and keeping operations flowing smoothly during prolonged staff shortages.

This article is a collaborative effort with ZOLL Data Systems.

 

[i]  “Ambulatory Surgery Centers in the US – Employment Statistics, 2002 – 2026.” IBISWorld website, www.ibisworld.com/industry-statistics/employment/ambulatory-surgery-centers-united-states/. Accessed 12 Nov. 2021.

[ii] “Intellimarker 2018 Multi-Specialty ASC Benchmarking Study.” VGM Health website, https://bit.ly/3xLtLKg. Accessed 12 Nov. 2021.

[iii] “2020 AMA prior authorization (PA) physician survey.” American Medical Association website, www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf. Accessed 12 Nov. 2021.

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