Precertifications are one of many hassles ASCs face when securing reimbursements.
John Lewis, CEO of Semmes Murphey in Memphis, Tenn., spoke with Becker's ASC Review on why precertifications are burdensome as well as other financial issues at his center.
Question: What reimbursement issues affect revenue most at your ASC?
John Lewis: A couple of issues are impacting us from a financial perspective.
1. As more financial burden is being shifted to patients, ultimately the risk of collection ends up with our practice. We are seeing more and more patients who have limited ability to pay. As the collection process is becoming increasingly burdensome, we have to be much more strategic throughout the entire process and especially in how we communicate with patients along the way.
2. Precertifications are one of our biggest challenges not only in our ASC, but throughout our clinic. Payers are now requiring an enormous amount of information, and their response times seem to be expanding constantly.
I believe the increased response times are at least partly being driven by the fact that many of the payers are experiencing staffing challenges, much like we are. In the end, not only does a complicated precert process impact surgery center revenues, but it makes our surgeons much less efficient when a case does not get approved.
From a patient perspective, many patients don’t understand the precert process. All they know is that their case can’t be done, so it can lead to patient dissatisfaction. As a result, precerts have become a much more significant metric that we monitor each day.