Two ASC leaders recently joined Becker's to discuss where ASCs are losing money.
Editor's note: These responses were edited lightly for brevity and clarity.
Les Jebson. Regional Administrator at Prisma Health (Greenville, S.C.): Scheduling procedures or cases that may have uncertainty or variability in overall case time or supply utilization. For those procedures that end up being more technically complicated, and thus, often needing more resources, they can create a per-case loss for some ASC settings. A well-managed ASC should minimize case variation and manage patient acuity accordingly, thus mitigating the possibility of losing money. This is a challenging task and one that many ASC administrators work in tandem with their surgeons to manage.
Todd Neiss. Business Manager of Bismarck (N.D.) Surgical Associates: Where ASCs are losing money right now is with payers not processing claims correctly. They deny claims that should be paid or have a third party process claims that don't even follow the payers' policies and guidelines and they deny claims that should be paid. You fight for these claims to get paid, and they require you to appeal and you find out that the appeal is being sent to the same third party processor, and they automatically deny, citing the exact same reason the claim was denied in the first place. They didn't even look at the supporting documents included with the appeal outlining why the claim should be paid. Then finally, you are able to submit a second level appeal, which is then reviewed by the payer and you get someone who reviews the information and our claim gets paid.