With the Patient Protection and Affordable Care Act insurance policies that now require stricter verification of coverage details, and changes in allowable, deductibles co-pays and various prior authorizations required, the Ambulatory Surgery Center reimbursements have been affected. Besides these increased regulatory pressures and changes to private insurance coverages, they also face inequitable treatment as compared to their HOPD counterparts. Further, the ASC reimbursements are being impacted by their performance on five quality measurers under the CMSb ASC quality Reporting Program, which has been effective with the CY 2014 payment determinations. Hence, although investing in ASCs is known to improve a physicianbs lifestyle providing an ancillary income for their practice; and where CMS and private players pay more when ASCs tend to provide specialty care services; the need for a strategy to increase revenue, eliminate inefficiencies, and create effective processes, is still essential.
Review your policies and procedures:
It is essential in these changing times of healthcare reforms and ICD-10 coding and billing system, workflow is efficient. Verification and eligibility checks are essential and a patient payment policy in place. Also work closely with patients so that they understand the new policies put in place that affects them
Review contracts & Workflow efficiency:
Check out all underpaying policies, review procedure codes, work closely with billers, and add services that can complement your revenues. Lack of follow up on contracting renewals and amendments can turn out to be a costly affair. Cross-training staff and employment of part-time staff, is a good way to increase efficiency at work
Budget for income:
With the changing Medicare allowable, sequestration and PPACA multilevel coverage policies, and seasonality of business, one needs to plan the entire year much in advance, as some quarters will be better than others. So it is very essential to keep revenue reserves
With the new ICD-10 coding and billing system, documentation is very critical. This also helps in denial claims, as proof is readily available for resubmission. So learn to start putting in documentation as fine-grained as possible. Electronic Health Record (EHR) & Electronic Procedure Documentation (EPD) software are essential in todaybs changing healthcare climate. Analysis of the situation before deployment is critical.
Employing Right Technology:
It is always a good practice not to accept manufacturer claims at face value. Adding new equipment and procedures is beneficial but it is always wise to spend the dollars. Do check with colleagues and review studies carefully. When you join Group Purchasing Organizations (GPOs), that have greater negotiating power with vendors, and demand for better rates, you can save a lot in terms of expenses and effort.
One must see that the experience for the patient must be excellent and referrals encouraged. The latter can be pushed in two ways: a) by hiring a part-time marketing representative who can interact with the referral sources, keep in touch and bring in that personal touch which brings in significant ROIs down the pipeline; b) patient referrals word-of-mouth is the most powerful and effective way to increase the revenue of your practice.
Against this changing background of increasing costs, downward slide of reimbursements, and regulatory scrutiny, ASCs following certain time honoured best practices integrated with new technologies and procedures will help in the next step forward towards increasing their medical revenue cycle management needs for a more effective patient satisfaction.