Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

5 Revenue Cycle Trends for ASCs, Ambulatory Practices

By Jacqueline DiChiara

- Ambulatory practices and ambulatory surgical centers (ASCs) – outpatient healthcare facilities providing same-day surgical care as an alternative to a hospital stay – have specific revenue cycle needs that require unique attention and consideration.

ambulatory surgical centers revenue cycle

ASCs are a booming entity of the healthcare spectrum when it comes to numbers. “In 2013, 5,364 ASCs treated 3.4 million fee-for-service (FFS) Medicare beneficiaries, and Medicare program and beneficiary spending on ASC services was $3.7 billion,” as the Medicare Payment Advisory Commission reported.

Here are 5 tips and noted trends for ASCs to contemplate acting upon to help strengthen their bottom line and maintain a healthy, prosperous revenue cycle.

Focus on quality of patients, not quantity

Consider that the implementation of Electronic Health Records (EHRs) may actually decrease productivity for ambulatory practices. As reported, researchers note a direct link between EHR adaptation and declining ambulatory practice productivity. As smaller practices are generally slower to integrate EHR implementation, a small percentage of ambulatory practices choose to digitize their patient health records, even as meaningful use regulations under the Medicare and Medicaid EHR Incentive Programs offer financial padding of sorts to do so, explains.

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Money is generally a centrally affected facet when such occurs. According to a study from the Journal of the American Medical Informatics Association (JAMIA) from Lucila Ohno-Machado, MD, PhD, practices are indeed receiving more reimbursement because they are seeing fewer patients. A solution to reimbursement hiccups, says Ohno-Machado, is to advance EHR functionality to incorporate analytics. Although it is likely fewer patients will walk through the door, a benefit of doing so is essentially being able to see the right patients, she says.

Make front-end training a top priority

A high number of claims denials can likely be cleanly traced back to problems stemming from your front-end staff, as Becker’s ASC Review confirms. Do not simply implement new software without training your staff how to properly handle claims submissions, says Becker's. Needing to resubmit denials due to system problems will waste valuable time, and money. If a front-end staff does not understand the billing system, claims will be denied, Becker's adds.

As reported, Medicare claims are denied about 5 percent of the time. An even greater surge of claims denial is expected come October when ICD-10 swings into full gear.

Develop an ICD-10 payment game plan

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Nonetheless, it is advised that ambulatory surgery centers in particular should develop a 3-month game plan for the remainder of the year following ICD-10 implementation in October. What if a staff member suddenly leaves? What if you need to hire a part-time biller to complete extraneous tasks into the evening hours? What if you experience a major crash? Expect the unexpected, as Becker’s infers. Additionally, plan for ICD-10 to affect Medicare to enhance preparation.

Keep coders’ skills from falling flat by conducting internal training where advanced training follows intermediate training to allow for adequate practice assigning codes to specific cases. Consider bringing in a consultant or an administrator to lead the initiative. Perhaps ask coders to dually code ever "nth" case as soon as possible if you have yet to do so. This will help identify areas of needed improvement before October hits.

Tread carefully with implant discounts

Money can be lost when it comes to implant discounts; such a concept is often overlooked. "One key strategy in reducing implant costs is to develop a capitated plate and screw plan with a key vendor," states Larry Taylor, President and CEO of Practice Partners in Healthcare. Prices that are more economical in nature can increase case volume which in turn helps business grow. Continue to reevaluate surgical implant discounts and be sure to educate physicians about cost matters to increase general financial understanding, Becker's confirms. Also, consider training physicians about implant pricing, Becker's adds.

Do not let outstanding balances slip away

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According to Becker’s ASC Review, “Run statements for patient-due balances frequently as they age up (weekly or even daily, as opposed to monthly); this will help centers stay on top of outstanding balances. Establish a set schedule for statement production and collection phone calls and have a set policy for making payment plans.”

After a 3-month period, collectability significantly declines. “At this point consider writing off the balance as bad debt (so that the value of the receivables on your corporate balance sheet is not inflated), and placing the account with a third party collection agency,” Becker’s advises. “If the collection agency recovers money on the account, deposit the funds in your accounting system (e.g. QuickBooks or Peachtree) as ‘bad debt recovery,’ but not in your practice management system, as the account is already zeroed out.”


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