The importance of ASC-specific expertise for billing success

If you're going to entrust your ASC billing to another company, you're going to want that company to be experts in revenue cycle management. That may seem obvious, but what can be a difference-maker between whether the company takes your ASC's revenue cycle performance to a higher level or leaves you in worse shape is the type of expertise the company brings to you.

After all, ASCs are not hospitals or outpatient departments. ASCs are not medical groups. ASCs are unique in numerous ways compared to other organizations. That's why the company you partner with for RCM services must have expertise in those areas of ASC operations that can affect bottom line success — not only in terms of revenue generated and maximized but also ensuring revenue is captured in a manner that's appropriate and does not put you at risk.

Here are five areas of expertise to look for in an ASC billing company.

1. ASC-specific RCM

For a billing company to deliver the results a center needs to remain profitable, the company must understand the revenue cycle processes and components specific to ASCs, including how each affects the revenue cycle and what's required to navigate and factor them into a center's billing program. For example, an RCM company must understand:

  • important financial key performance indicators and metrics;
  • how procedures are covered by Medicare and commercial payers;
  • how commercial payers view ASCs within their book of business and calculate reimbursement;
  • how supplies and devices are factored into reimbursement; and
  • contractual language and how to load contracts.

2. ASC-specific qualities

A billing company cannot effectively support its ASC clients if it does not have a strong grasp of what makes surgery centers unique beyond specific RCM qualities. Understanding this uniqueness — and the characteristics it encompasses — is essential for everything from collaborating with ASC staff, to identifying coding and billing opportunities and mistakes, to knowing how to approach patient collections.

Such characteristics include the specialties and procedures appropriate for ASCs; importance of leanness for staffing, space and budgets; and processes for purchasing high-cost medications and implants as well as investing in capital technology and equipment.

3. ASC-specific practice management systems

The initial days and weeks of an ASC's collaboration with its billing partner are vital to short- and long-term success. This is when foundational processes are established between business partners and when patient and financial data are shared by the ASC and assessed by the billing company. Few things can stifle this work like a company's lack of familiarity with the ASC's practice management system that captures the data required for the company to deliver revenue cycle services.

If the system is new to the company, the interfacing necessary for end-to-end data integrity will need to be developed — if even possible — and billing staff will require training to learn the system. Such a lack of understanding can slow productivity and performance while increasing the likelihood of errors that contribute to claims delays, denials, missed billing opportunities and other problems.

4. Compliance

Beyond helping its ASC clients get paid for procedures, a billing company must ensure all processes supporting RCM are compliant with rules and regulations. In addition, a good billing partner will support an ASC's other compliance efforts and initiatives.

Compliance concerning RCM encompasses a wide range of issues. First, there's coding and billing. Coding is a complicated process, with rules that undergo frequent changes. An ASC billing partner should employ experienced, certified ASC coders who are kept abreast of rules changes. 

Knowing how to bill one payer does not equate to knowing how to bill all payers. While billing rules sometimes overlap between payers, there are typically differences that must be understood for ASCs to submit clean claims and receive correct payments. Billing companies should employ billers with ASC-specific billing expertise, including billing multiple payer types and plans.

Compliance with documentation requirements is also essential. An ASC billing partner should have processes that prompt its staff to verify they have received necessary documentation prior to claim submission and submit this documentation with the claim.

Then there's HIPAA compliance. An ASC billing partner should be willing to sign a business associate agreement, undergo an assessment of its compliance with HIPAA regulations, and share how it maintains data integrity and can prevent and detect data breaches.

Finally, there's compliance with technology requirements. To provide RCM services, an ASC billing partner will use its own technologies and the technologies used by its clients, like practice management systems. These services and technologies should comply with security best practices and standard-setting bodies.

5. Security

Financial success will be naught if an ASC billing company fails to protect its clients' sensitive data. A security breakdown that leads to a breach and theft of client data could cause financial, legal and reputational challenges for the billing company and its partner ASCs. It's imperative that an ASC billing company treat all layers of security as a top priority.

The company should keep current with best practices for security management. It should treat security and compliance as complementary. The company should have strong security and compliance leadership who understand the complementary nature of the functions and work closely together. When this is achieved, the company will perform better in these areas, as will its clients.

An ASC billing company should invest in essential security solutions, including data encryption and endpoint detection and response tools. The company should also provide ongoing security training to its staff and undergo routine assessments to identify improvement opportunities.

Finally, a billing company must maintain an overarching commitment to continuous improvement. This should extend to how the company manages risk and the steps it takes from a security standpoint.

Choose your ASC billing partner wisely 

It's of critical importance that ASCs perform due diligence before choosing a billing company partner. Companies vary greatly in the types and quality of services provided and the industries where they truly specialize. The partner selected should be well-equipped with the ASC expertise to provide substantial and sustainable revenue cycle improvements.

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Appreciating the value of ASC billing expertise: Q&A with Surgical Notes' Ken Bulow

Ken Bulow is executive vice president of operations for Surgical Notes.

Question: What do you view as some of the most important types of ASC billing expertise surgery centers should look for in a billing partner?

Ken Bulow: The company must understand the month-end, hard-close process. This does not exist in the physician or hospital space. What is particularly unique to ASCs is determining at month's end how much revenue the center generated, even if all cases are not billed yet. 

If you work with an expert in this area, they will have defined month-end processes that will help ensure all your cash is posted and you have an accurate reflection of the work you performed and your expected revenue. That is a significantly different outlook and approach than how the rest of healthcare works. Without the right partner, you're not going to receive those types of information.

Also critically important is knowledge of the practice management systems ASCs use. There are just a few main software vendors in the space. If a billing company specializes in practice or hospital systems, they will be working at a distinct disadvantage compared to one that knows ASC systems inside and out.

Q: What can ASCs do to help maximize the benefits of working with a company possessing ASC expertise?

KB: Leverage their knowledge of those qualities that make ASCs unique, such as implant billing, high-cost drugs, and managing postoperative pain. The company should have what are essentially off-the-shelf processes you can implement that will help you ensure accurate, complete documentation of your case work so you can bill and get paid for it.

Another benefit an ASC billing company should provide is updates about regulatory developments. For example, Medicare issues updates every quarter and then a more significant update annually. The company should help you understand whether and how such updates affect your ASC and its procedures.

Q: What are some qualities an ASC may overlook or underappreciate when researching partner options? 

KB: The tools and technology used internally for a company's staff. Something we do at Surgical Notes is provide our staff with a list of their work for the day. This helps ensure every denial is worked within 24 hours, every underpayment is worked within 24 hours and every piece of correspondence is resolved within 24 hours.

Reporting expertise is also essential. The systems used in ASCs today can provide a lot of helpful data. You need a partner that can get the right data out of those systems to help you with various projects you may be trying to complete, such as payer contract negotiations, physician recruitment, benchmarking, and other financial needs like securing a loan or refinancing. You want a partner that knows the data well and knows their way around the data so they can help you make sound business decisions that take into consideration the uniqueness of your enterprise.

Contact Ken Bulow at ken.bulow@surgicalnotes.com.

 

Surgical Notes is dedicated to providing best-in-class revenue cycle solutions for the ambulatory surgery center industry. By integrating Surgical Notes' suite of products and services, ASCs have access to an enterprise revenue cycle solution designed to maximize profitability, physician distributions and business office efficiency.

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