Consider improving processes in these four areas as your center adds more complex procedures to its list
Driven by continuous successful outcomes in the outpatient setting, ASCs have emphasized incorporating more complex procedures into their repertoires as a formative growth strategy.
However, adding complex procedures like total joint replacement, cervical disc replacement or implantable cardioverter-defibrillator (ICD) implantation to an ASC’s procedure list does not automatically translate into increased revenue capture or higher profit margins because these complex procedures can present unique challenges. The solution is to identify and monitor specific metrics that help you track and review your revenue capture, ensuring your ASC is growing with intention.
Metrics and Processes to Review
Recognizing key metrics and improving processes in four key areas can help ensure your ASC’s growth is targeted, beneficial and sustainable.
1. Front Desk Operations
Identifying a robust set of metrics that monitor your front-end operations can help ensure that your front desk staff and technologies are supporting your facility’s success. Metrics in this arena can measure:
- Rate of demographic errors: Correct patient demographics are critical for a high rate of claim accuracy.
- Authorization errors: Authorization requirements might periodically change or vary by payer, region or other factors. Be sure to review any procedure with high error rates.
- Patient satisfaction and price transparency: A 2020 survey from Transunion showed that up to 60 percent of patients are likely to pay for procedures up front when presented with a cost estimate. This, along with growing legislation targeting transparency, makes pricing visibility at the time of service a priority focus for ASCs.
Your ASC can limit errors, in part, by embracing robust front-end training and best practices for demographic capture and patient eligibility screening
2. Medical Coding
Complex procedures create distinct challenges for medical coding. As the error rate increases so does the cost of those errors. That is why your ASC should pay special attention to the following:
- Procedures with high medical coding error rates: Some complex procedures such as implantation of neurostimulators and spinal cord stimulation are more likely to be audited by the Centers for Medicare & Medicaid Services (CMS) or by recovery audit contract providers (RACs).
- Internal error rates: Your ASC does not have to wait for a CMS or RAC audit to determine whether errors are plentiful. Instead, audit your own error rate. You can then institute best practices to limit your exposure to future recoupments and refunds.
3. Denials Management
The ASC revenue cycle can be incredibly complex and nuanced. This can make establishing metrics for reimbursements and denials a challenge or, at the very least, time-consuming.
ASCs can often benefit from running a revenue cycle assessment. This assessment can help determine overall trends and how to improve your clean claims rate. Knowing which procedures result in higher rates of denials can help improve your processes.
4. Managed Care Contracting
Make sure your managed care contracts are working to your advantage. Often, these contracts are negotiated under a set of assumptions that do not translate well to more complex procedures.
Whether your ASC partners with a revenue cycle management firm or has an internal managed care contracting process, it will be important to review the following:
Make sure your managed care contracts are working to your advantage. Often, these contracts are negotiated under a set of assumptions that do not translate well to more complex procedures.
Whether your ASC partners with a revenue cycle management firm or has an internal managed care contracting process, it will be important to review the following:
- Crosswalks, amendments and fee schedules within all your contracts.
- Staff training, so your employees are aware of your managed care contract structures and how they affect reimbursement.
- The relationship between costs and reimbursement. A full analysis can help identify which managed care contracts are working for your ASC and which are not.
Metrics Can Position Your ASC for Growth
As your ASC grows, revenue cycle management (RCM) metrics can help you more clearly see successes and opportunities. Engaging with third parties to help assess your revenue cycle can present more clearly where your ASC is positioned for growth and where simple enhancements could make a big difference.
Auditing your RCM processes can help identify and prioritize the metrics most critical to your center. Monitoring the right metrics and processes can help your ASC more successfully incorporate complex procedures into your growth strategy.
By Kylie Kaczor, MSN-RN, CPCO, CPHRM, CMPE, CASC, CLSSBB, ACHE, Senior Vice President — Clinical and Regulatory Affairs, National Medical Billing Services
Originally published on ASC Focus, adapted for the National Medical website.
This post was published July 5, 2022