Ambulatory surgical centers have certainly been a revolution. However, there are some surgical procedures wherein the physicians working at the facility have been subjected to a pay cut or the revenue generated for their procedures has not been fully paid for.
Well, there are various reasons that are hampering the revenue cycle of ASC’s, but the most problematic region for the losses is improper medical billing and coding structure. Yes, you heard that right, because this has become a falling trend where in-house accounting department is finding it difficult to verify and code the perfect procedures, while tackling the perquisite of healthcare providers as well.
While procedures like spine, orthopedic surgery and ophthalmology are known as top revenue generators, specialties like plastic surgery, oral surgery and urology are regularly facing revenue losses.
Here is a list of procedures where ASC’s are losing money.
What makes it appalling: With a 12 percent undesirable rate on the Healthcare Appraisers review, gynecology ties with podiatry, GI and ophthalmology as the loss making procedures, yet it has lower rates than the others. Gynecologists who still do obstetrics are part-time specialists, so they have low surgical volume to begin with, and afterward a bit of that work completed at the hospital and not the ASC. This leads to lower bottom line for the ASC’s.
Many gynecologists have dropped deliveries and are focused on surgery. They could be an aid to the ASC if they perform the procedures at the center and not at the doctor’s office.
What makes it poor: Podiatry as a profession is already slipping below many new procedures that have replaced certain feet and ankle surgeries. Because of their low volume, they’re not a decent source of income for ASCs. A busy podiatrist performs just 80-100 cases a year. Podiatry makes up a normal of 4 percent of all cases in ASCs, as surveyed by VMG wellbeing. Though a turnaround of sorts could be managed by outsourcing medical billing and coding facility, increase in patient numbers solely depends on the management of the Podiatry services of the facility.
What makes it terrible: Urology was the second least alluring specialty in the Healthcare surgery, however with an 18 percent undesirable rate, it stood head and shoulders above plastic surgery. A ton of urology procedures are performed at the doctor’s office itself. Urologists might be enticed to do those procedures at the office as the expert charge is higher. In some cases, ASCs have forced physicians who move their case to the office to offer back their shares and leave the facility.
Such a scenario could be avoided if Urologists who reliably do their cases in the ASC ought not be an issue if rates are arranged appropriately.
What makes it a loss: Oral surgery according to the Healthcare Appraisers review scores at the bottom in procedure specialties as oral surgery has low volume. An active oral specialist can perform just 40-50 cases a year, which can’t even justify the cost of equipment required. Moreover, repayment doesn’t take care of expenses. Numerous oral surgery patients are secured by Medicaid, and even the individuals who do private pay represent too little volume to legitimize putting the ASC’s bottom line clout hanging in the balance to get higher rates.
What makes it lose money: Last and not the most favorite as far as ASC revenue generation is concerned is Plastic surgery. You’d be astonished knowing the number of facilities losing money on each and every plastics case they do. Plastic surgery’s poor reputation as a loss making ASC procedure is mainly due to the payment structure created around it. This is the reason why many plastic surgeons operate their owned clinics and to make the payment structure simpler and more viable outsource the services to an external medical billing and coding company. Keep in mind that cosmetic surgery, which is affiliated with plastic surgery has to be paid out of pocket, which makes it even harder to be a part of the ASC facility in many ways.
The moot question that we need to address here is that not only the above mentioned procedures are hampering the revenue structure of an ASC. But, there are other segments such as the accounts department, the healthcare providers and the medical billing and coding team that also needs to be in tandem with the procedures undertaken. With data analytical tools and predictive modeling available, Ambulatory Surgical Centers now need to look beyond traditional supports to increase their revenue cycle. An effective billing can improve cash flow, generating error free claims whilst reducing the number of denials and rejections.