Many intricacies of ambulatory surgery center operations spark questions across the industry. Michael Orseno, revenue cycle director at Regent Surgical Health, addresses four of the most common ASC billing queries. 1. What is the gold standard for A/R days outstanding? Though revenue cycle management would be easier, there is no one ideal number for accounts receivable days outstanding. The target number varies from center to center, dependent upon factors such as payer mix and case mix.
"For example, center A has a days in A/R metric of 46 days and center B has days in A/R of 30," says Mr. Orseno. Center A at 46 days has a high percentage of OON and/or workers' compensation cases, while center B with 30 days has a high Medicare volume. Center A would have healthy A/R for its payer mix, while center B may not be as efficient. A center with a high percentage of Medicare cases can achieve A/R days in the low 20s, he says. Days outstanding metrics can be deceiving when they're not put in the right context, he says.
Out-of-network volume often increases A/R days, with the trade-off of potential higher reimbursement. Market location also plays a role. The key to keeping on top of A/R days is benchmarking against similar centers.
2. What is the best information management system for ASCs? Here are seven key features of an information management system that will be a good fit for the ASC environment.
• Ability to perform facility billing (i.e., not practice management software)
• ASP Model to promote business office efficiency
• Electronic billing
• Robust reporting package
• Ability to extract data into Excel in order to perform analysis
• Instant insurance verification
• Ability to scan patient records into their charts
• Compatibility with other software applications
3. If we decide to transition from paper to an electronic system, which should we buy? Before transiting to an electronic medical record or electronic health record, Mr. Orseno recommends all ASC leaders determine if the return on investment will support the switch. If the financial analysis supports purchasing a system ASC leaders have a choice between an EMR and an EHR.
EHRs, which will store an ASC's clinical and financial data, tend to be less expensive. EMRs, while more of an investment, go beyond storage and allow for comprehensive data sharing and usually involves a physician dictation component. Whichever option an ASC decides on, one of the most important features the system can have is the ability to interface with center's other software programs. "You need to consider the initial outlay of the cost, as well as the additional time and money it will take for customization," says Mr. Orseno.
4. When is the right time to consider switching to outsourced billing? There are pros and cons to both in-house and outsourced billing. Here are five signs that outsourced billing is the right choice for an ASC:
• Business office talent is difficult to find
• Business office staff turnover is high
• Cash metrics are not meeting national standards
• Staff is inefficient
• Technology is too outdated to support staff efficiency
"A lot of firms, Regent included, offer free business office audits to determine if you are leaving money on the table," says Mr. Orseno. "The savings that are found in the audits will often offset the fee of outsourced billing."
More Articles on Coding and Billing:
5 Top ASC Documentation Issues Impacting Reimbursement & Their Solutions
ASC Implant Carve-Outs: Opportunities, Challenges & 4 Best Practices
Top 5 Physician Specialties With Unexpected Denials