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Effective Billing ASCs

Opening a new surgery center requires a significant financial outlay for investors. There are those costs associated with developing the physical plant, purchasing equipment and supplies, and hiring and training staff. Once an ASC opens, expenses are ongoing, including supplies, payroll, maintenance costs, rent (if the building is not owned), and insurances. 

ASCs must have the means to get bills out the door for procedures performed from the day the center opens and complete its first case. Doing so will help ensure the ASC can cover its ongoing expenses and allow owners to begin recouping their investment.

Here are 10 tips new ASCs should follow as part of their efforts to establish and then maintain effective billing processes.  

1. Be methodical with staff

Staff performance can make or break an ASC's billing. If staff are unable to complete their billing task responsibilities efficiently and correctly, bills may not go out the door in a timely manner, and even if they do, payers may deny claims due to errors.

A new ASC should allocate ample time for recruitment and hiring of its initial billing staff. Rushing the hiring process can lead to the selection of candidates who are not great fits for the roles they are expected to fill, which will increase the likelihood of billing problems. A new center should also allot enough time to adequately train new staff on the ASC's billing processes and policies.

2. Set reasonable, achievable goals

Setting billing goals is essential for motivating staff and measuring performance, and that's true even for a new ASC. Before you open, make sure staff members understand what is expected of them individually and the ASC revenue cycle team as a whole during the first days, weeks, and months of the facility's operation.

While you will want to set goals that require staff to push themselves, do not set unreasonable benchmarks. Gradually raise goals and expectations as time passes, and staff become more comfortable in their roles and working with one another. When discussing goals, solicit feedback from staff members on whether they believe the targets you set are reasonable and what the ASC can do to help them meet those objectives. 

3. Expect challenges

Don't fret when you experience bumps in the road with your early billing efforts. This is inevitable for any new facility. You can help reduce the likelihood of such obstacles to success by effectively engaging staff in the development of your billing processes and focusing on building a positive, supportive staff culture. When staff work better together, they are more likely to stay focused on the bigger picture of facility success and be less concerned about individual (i.e., siloed) performance. Effective teamwork should help bring problems to the forefront sooner and lead to overall smoother billing processes.

4. Revising processes is okay

It's difficult to know if the billing processes you put in place work as intended until they are put to the test — that is, you begin to bill for actual procedures. Once your ASC starts billing, you may find that one or more processes are inefficient or perhaps increases the likelihood of errors and missed steps. 

Don't hesitate to make a change that you believe will improve performance. It's better to try to fix a process that isn't working as well as it could than to stick with one just because it's what you originally planned. When you change a process, train staff on what is different and explain the reasoning behind the revision.

5. Maximize staff meetings

Whenever you engage in staff meetings — whether they be one-on-one or full-team meetings — work to make the most of your time together. This is especially important for a new ASC as you are working to create a foundation that will hopefully help drive success for years to come. 

Use these meetings to learn what staff believe is working well and what could be improved with your billing processes. Ask for feedback on everything from the processes themselves to the technology staff use, as well as the work environment as a whole. Find out if staff have the resources they need to succeed or if there's a tool that could prove helpful. 

These meetings are also excellent opportunities to discuss how the ASC is performing concerning meeting previously stated goals and request recommendations from staff for how to better meet or exceed objectives. 

6. Support staff

Those individuals working in your ASC's business office likely won't be the highest-paid in your facility, but they can be the most important to your success. You can have incredibly talented surgeons and clinical staff, but if their work isn't billed correctly, your ASC will struggle to remain solvent and open. 

Do all you can to support your billing team and help them succeed. This support comes not only in the form of a reasonable salary, benefits, and performance bonuses but also by offering opportunities for professional growth. Invest in books, webinars, and online courses. Send staff to local or national meetings. If staff members express an interest in pursuing a credential or degree that can help them in their role, consider helping cover some or all of the costs. The occasional catered breakfast or lunch is an excellent way to demonstrate appreciation.

While showing support for billing staff may require some money, investments can help improve performance and job satisfaction, which may ultimately lead to a positive financial return. 

7. Maintain an open-door policy

An extension of supporting staff, an open-door policy makes it clear that team members should not hesitate to approach and speak with management to share questions, concerns, and ideas. For new ASCs, such a policy is a great way of learning early about opportunities for improvement and challenges that require fixes. This policy is also an effective way of helping establish a culture that emphasizes support of one another regardless of title and stature within the ASC.

Furthermore, you may have team members who find that the positions they were hired for or the roles they were assigned are not a good fit. While you hope that the team you hire before you open will be with you a long time, you also do not want to keep people on board who aren't right for your ASC or are performing responsibilities that are too difficult. An open-door policy can help encourage these individuals to speak with management sooner rather than later.

8. Measure performance frequently

The early days of an ASC are a critical time in the facility's history. As noted, this is when the foundation is established, and hopefully, it is a solid one. During those initial days, weeks, and months, you should measure the performance of individual billing team members and the overall team frequently. Are they doing as well as you hoped? Are goals being met? Where are you excelling, and where are you struggling?

Measuring performance is vital to determining where to focus improvement efforts and spotting any potential "bad fits" from a staffing perspective. The results of performance measurement also provide topics for discussion and brainstorming during staff meetings.

9. Investigate every issue

As the idiom states, "Where there's smoke, there's fire." If you detect a problem in your billing processes, perform a comprehensive investigation to determine the cause(s) and implement a solution(s) as fast as possible. While this is important for any ASC, newer surgery centers cannot afford to allow poor practices to become the norm. When undesirable practices become routine, they become much more challenging to fix.

Furthermore, if a problem isn't properly investigated and resolved, it will only magnify over time. New ASCs need strong-performing processes that generate positive cash flow from the get-go or else owners may be required to invest even more money into the center.

10. Celebrate successes

The opening of an ASC is a stressful time. Tremendous money and time are invested. People have stepped away from their jobs and accepted roles in a new entity without any guarantee that the business will be successful. Even with ample preparation, there's still a lot that can go awry.

But the opening of an ASC is also an exciting time. The new facility will provide patients with high-quality, low-cost surgical care. A team has come together — likely from all over the community and possibly much further — to help create a business that will hopefully remain open for many years and help numerous people in the process.

As your center achieves business-related milestones and meets — and maybe even exceeds — performance goals, celebrate these moments with your billing staff. Recognize individual and team performances. Bring attention to the crucial work of the folks behind the scenes that help keep the doors open and the lights on. By doing so early and then on an ongoing basis, you'll help motivate staff to elevate their performance and boost morale and loyalty — all while showing staff whose work often goes unacknowledged that they are greatly valued and appreciated.

Billing on Day 1: What New ASCs Need to Do