Caryl Serbin, RN, BSN, LHRN, is executive vice president and chief strategy officer for SourceMedical.
Q: When should an ambulatory surgery center consider outsourcing its billing and collections?
Caryl Serbin: There are several circumstances when an ASC should explore outsourcing its billing and collections. They include the following:
- When struggling to find and retain qualified staff.
- When billing results trail far behind standard benchmarks.
- When revenue is decreasing while volume is increasing.
- If there are compliance concerns.
- When audits reveal significant issues.
- For new centers lacking a strong business office.
Q: What are some of the factors you have seen that convince ASCs to outsource their billing and collections?
CS: As with the situations identified before, an ASC will often turn to outsourcing due to staffing challenges, including a lack of qualified staff members and the sudden departure of a critical member of the business office, as well as the high cost to pay for an extensive, qualified business office team.
There are also non-staffing challenges that motivate this change, including the constant changes in reimbursement by government and third-party payors, volume spikes which keep staff busy on some days but less active on others, and just general frustration with the challenging billing and collections.
Q: What problems does outsourcing really solve?
CS: If you partner with a good billing company, you could eliminate many of the headaches that come from billing and collections. Staffing issues become less of a concern; you practically cut out recruiting, hiring, education, turnover, as well as cost of salary and benefits. As you grow, you will not need to add more staff. Less staff means you can use space in your ASC for other operations, or if you're developing a new center, you can build a smaller facility.
With outsourcing, you also eliminate the headaches that come with technology changes, increasingly complex revenue cycle and regulatory changes, fighting managed care companies over denials and back-up of billing data. This allows an ASC to focus more time on growing volume.
In addition, outsourcing companies will often have the resources to help with other areas of concern for an ASC, including managed care negotiations, state reporting, internal and external auditing, fee schedule development and financial benchmarking.
Q: If an ASC decides to outsource, is there anything relating to billing it needs to keep in-house?
CS: Outsourcing billing does not mean an ASC can forget about all billing and its associated compliance issues. The surgery center will need to at least retain a contact person to get the billing company the information it needs to properly handle the AC's billing and collections. Physicians will still need to dictate operative notes accurately and in a timely fashion. The ASC will need to remain knowledgeable about its accounts receivable and be prepared to become involved if a payor issue arises, such as a failure to honor contract language.
A surgery center will still need to assist with problem solving associated with managed care and continue to perform upfront processes such as registration and insurance verification.
Q: What services should an ASC expect when outsourcing?
CS: On a basic level, most outsourcing companies provide coding from the operative note within 24-48 hours, implant billing, accurate contractual adjustments, daily payment posting, fee schedule analysis and maintenance, resolution of software or clearinghouse issues related to billing, loading of managed care contracts and any updates, compliance and HIPAA programs, timely refund recommendations and enforcement of prompt payment laws.
Optional services may include managed care contracting, state reporting and benchmarking.
Q: What are some of the key qualities an ASC should look for in a billing company?
CS: There are many qualities for a good outsourcing company. ASC billing experience — versus just medical or hospital billing — is definitely a plus, as is experience with your type of center and specialties. Experience in your state can also help if your state has its own set of challenging rules and regulations.
It's definitely worth requesting and then checking references. This will help confirm whether the company you are considering has a good reputation and will be a good partner to your ASC. Ask about the experience and credentials of the company's staff members as they will be performing the services for your center. Ask about managed care expertise, software expertise, if they have experience with your clearinghouse and your billing reports.
It's also worth asking about the company's disaster/recovery plans, how they protect and back-up your center's data, how they conduct (and how frequently they conduct) internal and external audits, if they are HIPAA-compliant and how they stay up to date on rules and trends.
Q: What does an ASC need to do to help make this partnership with an outsourcing company successful?
CS: An outsourcing company can only do so much on its own and will need an ASC to truly serve as a partner in this relationship. The center should communicate and meet regularly with its outsourcing company to help foster and ensure a positive working relationship. Timely response to billing company requests is key, as is quickly turning patients over to collections and following up on questions regarding operative notes or transcriptions. Also, providing ongoing education to center staff and physicians about the billing and collections process will help the partnership run smoothly.
Learn more about SourceMedical.
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