At the Becker's 20th Annual Ambulatory Surgery Centers Conference, held Oct. 24-26 in Chicago, Rebecca Overton, director of revenue cycle management at Surgical Management Professionals shared wisdom on strategies to secure profitable reimbursements for total joint surgery in an ASC setting.
1. Know each plan and its associated costs. Through understanding the different types of payment models you can better maximize your profits.
2. Examine your physicians' vendor preferences. Administrators must know what their ASCs' physicians are using for implants to come up with overall implant and supply pricing.
3. Break down payer mixes. A physician might bring unprofitable cases to a center from time to time. Knowing its payer mix can help an ASC determine which less-desirable cases it is equipped to take.
4. Continuously review your numbers. Reviewing finances only periodically may cause profit-lowering moves to fly under the radar.
5. Be aware of case caps, and avoid grouper pitfalls.
6. Have physician partners who want to do cases. It seems obvious, but foot-dragging surgeons are a potential problem. Don't have physician partners who don't bring the center business. In addition, if a surgeon brings a case at a loss, it may be a good idea to take the case anyway, if the ASC can make up for the loss on another case. If a surgeon takes a turned away case back to the hospital, he or she may bring a few other cases there, as well.
7. Create your own leverage. Have rationale on improved outcomes and financial gain available for potential patients so you can explain how the ASC procedure puts them at an advantage.
8. Share a case cost template with the scheduler's office. This makes it absolutely clear which cases the center should take and which the center should avoid. Administrators should also keep a close eye on scheduling, which can increase profits if optimally handled.
9. Look for opportunities to cut costs. Negotiate with vendors and communicate with physicians to get the best prices on materials for surgeries.
1. Know each plan and its associated costs. Through understanding the different types of payment models you can better maximize your profits.
2. Examine your physicians' vendor preferences. Administrators must know what their ASCs' physicians are using for implants to come up with overall implant and supply pricing.
3. Break down payer mixes. A physician might bring unprofitable cases to a center from time to time. Knowing its payer mix can help an ASC determine which less-desirable cases it is equipped to take.
4. Continuously review your numbers. Reviewing finances only periodically may cause profit-lowering moves to fly under the radar.
5. Be aware of case caps, and avoid grouper pitfalls.
6. Have physician partners who want to do cases. It seems obvious, but foot-dragging surgeons are a potential problem. Don't have physician partners who don't bring the center business. In addition, if a surgeon brings a case at a loss, it may be a good idea to take the case anyway, if the ASC can make up for the loss on another case. If a surgeon takes a turned away case back to the hospital, he or she may bring a few other cases there, as well.
7. Create your own leverage. Have rationale on improved outcomes and financial gain available for potential patients so you can explain how the ASC procedure puts them at an advantage.
8. Share a case cost template with the scheduler's office. This makes it absolutely clear which cases the center should take and which the center should avoid. Administrators should also keep a close eye on scheduling, which can increase profits if optimally handled.
9. Look for opportunities to cut costs. Negotiate with vendors and communicate with physicians to get the best prices on materials for surgeries.