MediGain, a global full-service revenue cycle management and healthcare analytics company, recently acquired ASC Billing Specialists. The acquisition falls in line with overall healthcare industry trends of consolidation to provide better services and care.
"ASC Billing has a very unique approach to some payment reform and an eye on the future," says Greg Hackney, CEO of MediGain. "They've made an impact on the ASC billing space."
While MediGain has had a presence in the ASC space, the recent acquisition will add expertise to the team. Here, MediGain and ASC Billing experts discuss five ways for ASCs to increase revenue and reimbursement levels.
1. Understand in network and out-of-network strategies. Depending on the marketplace, ASCs could benefit from in network, out-of-network or combined strategies. "We want surgeons to understand whether they should be in network with some payors and out of network with other payors, and how to really use that to their advantage," says Suzanne Webb, co-founder of ASC Billing Specialists. "It's hard to negotiate when you aren't doing the volumes that hospitals are doing. That's why we recommend most ASCs go out of network; otherwise you aren't going to be able to negotiate enough to cover your costs."
2. Concentrate on PPO business. Patients with PPO insurance plans have the highest potential reimbursement rates, so focus on bringing those types of cases into the center. "We really want centers to lower their Medicare patients and take in more PPO clients," says Ms. Webb. "Market [your center] to the general area to find employers who offer those benefits and consider how to work best with those employers to get their employees into your center, and then return them to work quickly. It increases revenue."
Surgeons often focus more on patient volume, but they don't understand that not every case is profitable. "Every single case coming into the center has a cost," says Ms. Webb. "You have to cover the cost on every single surgery and if you are only doing Medicare cases you are only breaking even, so there is no profit margin. If you want to decrease your cost, you have to lower the cases you are doing and do cases that bring in more money."
3. Monitor performance metrics. ASCs can decrease expense by monitoring their performance metrics and benchmarking against other centers to find areas where they can improve their performance. "A front desk or coding review can really help ASCs understand what the key drivers for high performance and improved efficiency are," says Eric Beier, MD, chief medical officer of MediGain. "We often find that not only can performance enhancement increase revenue, but also bring in more streamlined processes to help the ASC save money."
4. Increased IT and analytics investment. Future success with reimbursement will depend on proving quality and cost-effective procedures can be performed in the ASC. "I see the future going towards having much greater data analysis needs," says Dr. Beier. "Providers will need to understand and connect financial performance with clinical performance."
5. Build a team of experts. Surgeons are initially trained as clinicians, and many don't have business training. Surround your ASC with business and revenue cycle management professionals to take advantage of their expertise. "Some ASCs have very sophisticated business managers, but others do not, so having a very knowledgeable resource to depend on to give the best practices is valuable," says Dr. Beier. "You really need billing expertise and resources."
Experts can guide surgery centers through the payor mix analysis and help them optimize reimbursement at the center. "They will inform the ASC exactly what the best insurance carriers and PPO markets are coming from and help guide them to increase their revenue stream," says Kelly Webb, CEO of ASC Billing Specialists.
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"ASC Billing has a very unique approach to some payment reform and an eye on the future," says Greg Hackney, CEO of MediGain. "They've made an impact on the ASC billing space."
While MediGain has had a presence in the ASC space, the recent acquisition will add expertise to the team. Here, MediGain and ASC Billing experts discuss five ways for ASCs to increase revenue and reimbursement levels.
1. Understand in network and out-of-network strategies. Depending on the marketplace, ASCs could benefit from in network, out-of-network or combined strategies. "We want surgeons to understand whether they should be in network with some payors and out of network with other payors, and how to really use that to their advantage," says Suzanne Webb, co-founder of ASC Billing Specialists. "It's hard to negotiate when you aren't doing the volumes that hospitals are doing. That's why we recommend most ASCs go out of network; otherwise you aren't going to be able to negotiate enough to cover your costs."
2. Concentrate on PPO business. Patients with PPO insurance plans have the highest potential reimbursement rates, so focus on bringing those types of cases into the center. "We really want centers to lower their Medicare patients and take in more PPO clients," says Ms. Webb. "Market [your center] to the general area to find employers who offer those benefits and consider how to work best with those employers to get their employees into your center, and then return them to work quickly. It increases revenue."
Surgeons often focus more on patient volume, but they don't understand that not every case is profitable. "Every single case coming into the center has a cost," says Ms. Webb. "You have to cover the cost on every single surgery and if you are only doing Medicare cases you are only breaking even, so there is no profit margin. If you want to decrease your cost, you have to lower the cases you are doing and do cases that bring in more money."
3. Monitor performance metrics. ASCs can decrease expense by monitoring their performance metrics and benchmarking against other centers to find areas where they can improve their performance. "A front desk or coding review can really help ASCs understand what the key drivers for high performance and improved efficiency are," says Eric Beier, MD, chief medical officer of MediGain. "We often find that not only can performance enhancement increase revenue, but also bring in more streamlined processes to help the ASC save money."
4. Increased IT and analytics investment. Future success with reimbursement will depend on proving quality and cost-effective procedures can be performed in the ASC. "I see the future going towards having much greater data analysis needs," says Dr. Beier. "Providers will need to understand and connect financial performance with clinical performance."
5. Build a team of experts. Surgeons are initially trained as clinicians, and many don't have business training. Surround your ASC with business and revenue cycle management professionals to take advantage of their expertise. "Some ASCs have very sophisticated business managers, but others do not, so having a very knowledgeable resource to depend on to give the best practices is valuable," says Dr. Beier. "You really need billing expertise and resources."
Experts can guide surgery centers through the payor mix analysis and help them optimize reimbursement at the center. "They will inform the ASC exactly what the best insurance carriers and PPO markets are coming from and help guide them to increase their revenue stream," says Kelly Webb, CEO of ASC Billing Specialists.
More Articles on Surgery Centers:
5 Improvements to Make Good ASCs Great
Efficient OR Scheduling at ASCs: Q&A With Mary Ellen Rider of Maryville Surgical Center
5 Most Challenging Joint Commission Requirements for ASCs