ASC revenue cycle management is complex and resource-heavy, often straining in-house teams. Partnering with a specialized ASC billing firm can streamline claims, reduce denials, and boost financial performance through targeted expertise, technology, and compliance support.
Revenue cycle management plays a critical role in the financial viability of ambulatory surgery centers (ASCs). However, the process is complex, with many interdependent stages. One error at any stage of the process can cause a cascading effect that can impact efforts to submit clean claims and complete collections, ultimately hurting the financial health of the organization. Managing these complexities in-house is possible, but doing so requires significant dedicated resources, including staff with the requisite expertise to navigate the nuances of ASC revenue cycle management.
Fortunately, surgery centers have another option for getting paid: partnering with ASC billing companies that specialize in full or partial revenue cycle services tailored to ASCs. These ASC billing experts understand what it takes to submit clean claims, establish efficient workflows, reduce revenue leakage, and minimize claim denials. By outsourcing some or all of their billing, ASCs can relieve the burden of revenue cycle management and stay focused on their core mission: delivering safe, high-quality surgical care.
That said, it’s important to work with an ASC revenue cycle management firm you can trust with your financial health. Here are some of the must-have qualities to look for in a revenue cycle partner.
What's required for revenue cycle management success is not one and the same across the healthcare industry. ASCs have different challenges compared to other healthcare organizations, like hospitals or physician practices. Some complexities of the ASC billing process are unique, with specific protocols that must be followed for proper coding and compliance with payer rules and requirements. That’s why it’s so important to select a partner with extensive ASC expertise and experience.
How can you tell if an ASC revenue cycle management company has this expertise? Look for ASC billing companies that have a proven track record of delivering results to surgery centers nationwide and preferably within your state. They should demonstrate perioperative expertise that spans every stage of the ASC revenue cycle and have staff dedicated to specific roles, such as certified coders, billing specialists, and collectors. They should also be familiar with the ASC environment and be capable of working with all specialties and payers, like Medicare and commercial insurance.
Technology can be a big differentiator for ASCs looking to optimize the revenue cycle. As such, seek a partner that leverages powerful and innovative tools designed to support ASC revenue cycle management.
This includes business intelligence and analytics that can evaluate revenue cycle performance and provide actionable insights to improve priority key performance indicators (KPIs), advanced billing platforms that can streamline claim submission workflows and shorten the time to receive payment, and more.
It’s also important to consider integration. ASC revenue cycle management software should integrate seamlessly with the systems you’re already using, including anything from your practice management system to your EHR software and any other system that’s core to operations. This type of interoperability will make it easier to implement new tools and get them up and running faster without disrupting the rest of your ASC’s technology infrastructure.
Denials are an unavoidable reality in the healthcare landscape, and they’re costing ASCs and other healthcare institutes a significant amount of money.
Consider an Experian Health survey of more than 200 healthcare revenue cycle managers on the current state of claims management. The findings show that challenges such as claim denials, delayed reimbursements, and unresolved claims continue to intensify. According to the report, the most common reasons for denials include missing or incorrect data, lack of proper authorizations, and incomplete or inaccurate patient information.
It doesn’t have to be this way. ASC billing companies that have expertise in this area understand the major causes of ASC claim denials and how to prevent them. They can set up a streamlined appeals process as well as an extensive framework for denial management, which can help ensure that clean claims are submitted, denials are appealed as quickly as possible, and the revenue cycle continues to flow with minimal disruption or delay.
ASCs are subject to myriad compliance requirements. For example, on one end, there’s a need to comply with the rules and policies set by payers — something that’s not as easy as it used to be.
In line with compliance growing increasingly more complex, expensive, and difficult to adhere to, ASCs are also subject to legal and regulatory requirements on the other end. This includes both state and federal regulations, like the No Surprises Act and HIPAA.
ASC billing companies should be deeply familiar with the surgery center compliance and regulatory environment. For example, a good partner keeps tabs on all the latest regulations and notices rolled out by the Centers for Medicare & Medicaid Services as well as commercial payers and provides guidance to help their ASC clients remain compliant. This can help protect the revenue cycle by avoiding monetary fines and bottlenecks related to non-compliance.
Establishing a framework for ASC revenue cycle management is only the beginning. As your ASC grows and matures over time, that foundation needs to evolve and scale in kind. This may require updating revenue processes, implementing new best practices, acquiring more advanced technology, hiring more ASC billing experts, and other key initiatives — all of which can prove difficult.
ASC billing firms should have experience working with surgery centers of all types and sizes, from multi-specialty ASCs in urban centers to single-specialty centers in rural areas. This expertise can directly inform and support your strategic approach to revenue growth. As new procedures or specialties are added over time and more payers and patients come into the mix, a good revenue cycle management partner can help your ASC scale seamlessly and flex to meet demand as it shifts over time.
One concern ASCs may have in outsourcing ASC revenue cycle management is a lack of control over the quality of billing operations. Even the smallest coding, billing, documentation, or process mistakes can lead to denials or unnecessarily extend the length of outstanding payments.
For this reason, seek a partner committed to quality and demonstrates this by following strong quality assurance processes. What does this look like in practice? Quality checks may involve any of the following:
● Random sample audits
● Root cause analysis
● Claims scrubbing
● Peer reviews
● Error rate monitoring
● Data verification
● Compliance reviews
● Automated validation tools
An effective quality assurance process relies on standardized procedures, such as the checks outlined above, and includes routine benchmarking to evaluate performance. This ensures that your ASC revenue cycle management firm is delivering reliable results, supporting your operational goals, and maintaining compliance, even under the most stringent requirements.
Optimizing the revenue cycle is key to ensuring the long-term success of ASCs. By partnering with an revenue cycle consulting firm, you can trust their ASC billing experts to employ proven strategies that will keep the money flowing and deliver stronger bottom-line outcomes, so your staff can focus more on its patients.
Surgical Information Systems specializes in the complexities of ASC revenue cycle management, offering complete billing and coding services accessible to any surgery center — no matter what practice management system you use. Contact SIS today to learn how our revenue cycle experts can help boost your financial performance and profitability.