Outsourcing your revenue cycle management (RCM) can be an important investment in the success of your ambulatory surgery center (ASC).
However, it’s imperative that you ensure all of the responsibilities, protection and services are included in the final agreement.
Here are seven critical items you will want to ensure are included in the agreement.
1. Term. Length of contract term, including the date the agreement becomes effective and the expiration date. If the contract calls for automatic renewal, clearly define requirements for either party to terminate.
2. Use of legal Names. All references to the ASC and RCM company should reflect accurate business names. If businesses are incorporated, use corporation names.
3. Duties and responsibilities of ASC. Clear definitions of what the ASC is required to provide the RCM company, including, but not limited to, the following:
• Patient demographics
• Legible copy of patient insurance cards
• Access to provider procedure notes
• Explanations of benefits, if payment is received by ASC
• Notification of patient payments made to ASC
• ASC-specific software
4. Duties and responsibilities of the RCM company. Complete and detailed list of RCM company qualifications and provided services, including, but not limited to, the following:
• American owned and operated (all work performed in United States with no outsourcing of coding or other services to other companies or countries)
• Company employees with ASC experience
• Coding performed by certified coder(s) (verifiable credentials)
• Charge entry
• Payment posting
• Claims follow-up
• Patient statements
• Appropriate reports
• Complete transparency for all RCM transactions with real-time access
• Active, written compliance plan
• Red flag (identity theft) policy
• Coding and billing policies/procedures for RCM company employees
• Disaster plan, including protection of your data
• HIPAA-compliant secure connectivity
• Auditing program
• Errors and omissions insurance, bonded employees
• Assistance with center fee schedule development or changes
• Education of center staff regarding upcoming changes (e.g., Medicare/managed care reimbursement)
• Advise center when managed care contracts may need renegotiating
• Performing of state reporting, where required
5. Authority of ASC and RCM company. Definitions of the following areas of responsibility/authority:
• Where third-party payers and patients send their payments.
• Who handles ASC deposits specify checks and balances.
• Establishment of mutually agreeable policies for the following: write-offs, adjustments, refunds, minimum patient balances, etc.
• Acceptable time frame for accomplishment of duties for ASC and RCM company.
6. Fees. Fees should be based on collections (less credit balances), billed monthly to ASC. Stipulations as to minimum monthly fee and late payment fee should be included.
7. Other legal inclusions. Including, but not limited to, the following:
• Business associate agreement with HIPAA terms
• Mutual indemnification clause
• Non-disclosure of confidential information
Before signing any contract/agreement, it is wise to have your ASC’s attorney read and make suggestions for modifications, where necessary. Remember: Your ASC and the RCM company are entering a partnership. Each entity depends on the other for cooperation and ultimately for success for both parties.
Caryl Serbin, RN, BSN, LHRM (caryl@serbinmedicalbilling.com), is president and founder of Serbin Medical Billing (SMB), an ASC revenue cycle management company. SMB's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.