The popularity of Ambulatory surgery centers (ASCs) is quickly increasing. There are multiple factors responsible for this. More pressure is placed by federal and private payers on operating rooms to be price transparent. Since the service site is included in price transparency, inpatient surgeries have a lower chance for profit than before.
While ASCs are rising everywhere to meet this new demand, it is important for the providers to understand the inherent complexity in ASC billing. On the other side, healthcare insurance providers vary in their coding standards and frequently adopt new ones. You need an expert like Unify Healthcare Services by your side to understand and tackle the complexities of Ambulatory surgery centers.
In this blog, we will understand the challenges that arise in Ambulatory surgery centers and different ways through which they can be eliminated.
Let’s start by Understanding What Are Ambulatory Surgery Centers (ASCs)?
Ambulatory surgery centers (ASCs) refer to the specific facilities that are designed to perform outpatient surgical procedures. That is the reason why they are also known as day surgery centers. Billing procedures for ambulatory surgery centers (ASCs) can vary depending on the treatment location, and the nature of the center. However, a hospital-operated facility can also provide ASC services. For this a hospital must sign an agreement with the Centers for Medicare & Medicaid Services (CMS) to be covered by Medicare.
In the last few years, the Ambulatory Surgical Center (ASC) market has seen rapid growth. There were considerably more people towards the outpatient setting when it comes to quality surgery and increasing health costs along with insurance limitations. The ultimate solution is to outsource ASC medical billing. This can help you address your financial concerns and increase the profit rates of your practice.
Let’s understand the most common challenges in Ambulatory Surgical Centers Billing
Increase in number of Accounts Receivable (AR) days:
A/R refers to the average number of days that an Ambulatory surgery centers (ASCs) takes to collect payments for services they provide. Days in A/R are used as one of the main measures for the performance. On the basis of VMG Health data, Becker’s ASC Review reported that the average days in A/R for ASCs is 32. The AR days are impacted by the following factors,
- Procedure scheduling
- Patient pre-registration
- Insurance verification
- Patient financial counselling
- Patient payment plans
- Patient collections
As per a Beckers ASC Review report, having a patient financing solution that pays within just a few days of a procedure is helpful to reduce days in A/R. This will protect the ASC if patients default on their payment. . This was due to the improved reporting with enhanced statistics and withdrawing unprofitable route processes implemented in their medical billing process.
Cancellations
For ASC’s cancellations have always been a major concern. Here patients face high out-of-pocket costs for elective surgery. Therefore, many patients whose surgery is cancelled, may not reschedule as they reconsider their decision to incur the expense. If the cancellations are done by the patients on the same day, it has a tangible, negative financial impact.
It is important for the ASCs to not only work on identifying the causes of the cancellations but also take appropriate steps to deal with the problem. If proper communication with patients and tracking changes in the patient’s medical status is ensured, it can largely cut cancellations. Another strategy that is recommended here is implementing patient financing options. A report by Becker’s Hospital Review recommends providing a secured loan to patients for them to cover their surgical costs. It can largely reduce cancellations, decrease AR and increase cash flow within the healthcare practice.
Cases of Surprise Billing
These days another most common challenge is patients receiving additional bills from out-of-network providers. Sometimes this happens even after they have settled all their copays and deductibles. The problem is so huge that many states have passed laws to curb the practice of surprise billing. Various cautions are laid down so that providers operating in these states should understand laws to avoid lawsuits. In case of ASCs, they should also be wary of surprise billing or risk of losing patients. Providers can take the following steps to protect patients from surprise billing:
- Ensure that anaesthesiologists, pathologists and lab professionals are in-network.
- Timely inform the patient that in which cases these specialists cannot be brought in-network and in which cases the patient’s bill will include additional charges.
Keeping track of changes in coding
Another major concern of ASCs is to keep a track of CPT codes and ICD-10 codes changes. For instance, the American Medical Association (AMA) added 170 new codes, revised 60 codes, and deleted 82 codes. It is important for the ASCs to be aware of such yearly changes and implement them accordingly. One point to remember is that ICD-10 codes are also updated each October. The software systems of ASCs should also be updated with these new codes.
Partnering with an experienced medical coding company like Unify Healthcare Services can go a long way in keeping track of code updates. The professionals also help in implementing them to ensure error-free claim submission and accurate ASC medical billing for timely reimbursement.
Managing and keeping up with payer contracts
When it comes to managing payer contracts, ASCs face many challenges. This is because these contracts are subject to frequent changes. Also, different payers also have various rules and conditions with regard to care plans, local coverage determinations (LCDs), preventive care, bundled payments, and more.
A recent report from the American Association of Orthopedic Executives (AAOE) offers the following tips to manage payer contracts:
- Let the payer know why it is good for the payer to have the surgical center in their network and break through narrow/closed networks. Highlight unique service benefits, geographic advantages, and clinical/treatment benefits.
- Consider a blend of direct commercial payer agreements including both primary and secondary complementary payer agreements.
- Consider every concern about contracts’ language.
- To keep track of changes and contract expiry dates, Review contracts periodically.
- Understand rules of every individual payer.
Tips for Medical Billing in ASCs
Understand the Requirements of CMS
It is important to understand that which procedures are paid under CMS. The Center for Medicare and Medicaid Services only pay ASCs or some procedures. And in order to get timely paid, the operations must meet CMS requirements and sign a contract with the organization. The list of the procedures paid is available on the website of CMS. This website will also provide the details of covered ASC ancillary services, wage indices, and wage adjusted payment rates.
It is important to note that merely the guidelines of CMS are not helpful. ASCs should take its problems to its local intermediary or carrier. ASCs must constantly remain aware of how the organizations will overcome reimbursement issues.
Understand common health coding mistakes
The coding requirements for ASC’s keeps on constantly evolving. There are numerous bundling edits and regulations specifically for the surgery centers. For instance, Medicare requires physicians based outside the ASC to use different codes than physicians inside the ASCs.
Therefore, the proper way to eliminate the errors would be by understanding common coding mistakes. For example, there may arise the circumstances when surgeons are forced to perform open surgery when performing arthroscopic surgery. Different operations are separated by billers and claim can be filed for both. However, the only bill is for open surgery when a situation like this occurs.
Know the Standards of Medicare
It is important for ASCs to understand the approved list of procedures before committing to surgery. Medicare is not going to pay for surgery until CMS states that the operation will not cause a patient a certain level of risk. Additionally, operations that are done overnight are ineligible for coverage.
Hire a Medical Billing Expert for your ASC
If you want to keep high revenue caps while obeying coding restrictions, the ultimate solution for you is to outsource your billing to the experienced team like Unify Healthcare Services. Your in-house billing may not be experienced enough or able to provide your ASC with the level of expertise required. Consider hiring a professional billing company and avoid time-costly denials while reducing staff workload. Doing so will automatically accelerate your reimbursements in a long run!
