ASC industry experts share their experience in partnering with ASC billing companies
Surgical Information Systems (SIS) recently hosted "Exploring the Drivers & Benefits of Outsourced Billing for ASCs: A Panel Discussion." This webinar, now available as an on-demand recording, brought together experts for a discussion about outsourced ambulatory surgery center revenue cycle management (RCM) and the value it provides to centers that partner with an ASC billing company. The panelists were Colleen Ramirez, RN, CASC, Chief Administration Officer of Bone and Joint Surgery Center of Novi; Raghu Reddy, MBA, BS, CMR, Chief Administrative Officer of SurgCenter of Western Maryland; and Jessica Nelson, Vice President of Revenue Cycle Services for Surgical Information Systems. The program was moderated by Daren Smith, RN, BSN, Vice President of ASC Solutions for SIS.
The following is an excerpt from the webinar that provides the panelists' responses to several questions posed by Smith. It has been edited for length and clarity.
Colleen Ramirez (CR): One of the main reasons concerns my expertise. I'm a nurse. I have a lot of responsibilities at the surgery center. I can focus on assisting my teams from a clinical standpoint and allow someone else to handle our billing. I don't feel qualified to effectively supervise billing, institute the best practices and benchmarks, and do everything an outsourced billing company offers and delivers. They're the experts, and I love that. I've always wanted to collaborate with these experts instead of trying to become an expert myself.
Raghu Reddy (RR): We were a relatively new center that lacked billing knowledge and access to resources because we're in a small, rural town. Those were some of the reasons we initially looked at outsourced billing. At the time, we were managed by a management company. They already had a relationship with an outsourced billing company. But before we made the decision, we also looked at the pros and cons of in-house versus outsourced billing. We put the matrix together to help us with decision-making and the clear winner for us was the outsource model.
Some of the contributing factors included cost, space, infrastructure, and accounting for business continuity, such as staff taking vacation or sick leave. We also identified some of the benefits noted by Colleen: tapping into industry expertise and benchmarking resources. We considered a lot of criteria before we made the decision, which turned out to be an easy one for our governing board.
Jessica Nelson (JN): Colleen and Raghu hit on a lot of the hot points. More recently, we have heard from ASCs with in-house billing models that may have had billing staff on board for many, many years. Due to challenges like growing competition and losing their billing staff, ASCs are being forced to make very quick decisions on how to best move forward, and outsourcing is an easy, effective option.
When having an in-house billing team, a surgery center might not have the ability to offer remote work, which is increasingly desired by staff. Many of your revenue cycle management partners can offer this employment option, which helps them better weather the staffing challenges we're seeing.
CR: I think the number one quality is a long history of ASC billing experience. It's very, very different from other types of medical billing. That almost always has to be criterion number one. Hopefully, the company also has experience billing in your state.
Another important quality is the company's understanding of the ASC billing process as a whole, from registration to payment processing to correspondence and follow-up. They also need to have compassion. I think a challenge can be trying to connect your onsite team with your outsourced billing company and establishing those communication pathways, especially for trauma cases that come on last minute, and ensuring you have all the information you need for a clean claim.
I utilize an in-house billing supervisor. She works remotely, but I have hired her specifically to work directly with my RCM partner. She has expressed the importance of that compassionate quality because she says the billing process can be a little daunting, a little boring, and a little annoying. It is important for her that our billing partner has compassion and helps develop those communication pathways.
RR: I mainly look for some of the qualitative elements. A lot of companies claim to do ASC billing and have this expertise. What's important to me is not only that they can do the billing, but how well they communicate and how transparent they are throughout the whole process. If someone tells me that when I leave a message, they are going to call me back in 72 to 96 hours, that's a big red flag. There's so much that goes on here, like some of the trauma cases Colleen talked about or sudden code changes. The communication with the billing partner has to be seamless. That's paramount. I like to develop a strong relationship with the billing company, the customer service manager I interface with, and anybody else on the RCM team who supports us so we can work well together. That teamwork is absolutely essential for me.
Then there's the quality of staffing resources that the billing company brings to the table. Will they provide us people who are heavy hitters — an experienced biller, coder, charge poster, payment poster, collector? How does the billing company approach the hiring process to bring on quality people? Those are some of the more subtle things I look for, on top of what Colleen shared.
In summation, when a billing company can check all these boxes, you can have a very efficient and effective revenue cycle management process.
JN: My number one recommendation is to get started as early as possible. Whether you are a brand new surgery center considering whether to outsource your billing or are an existing surgery center that may be looking to change either from your in-house model or from another RCM vendor, your standard transition timeline is about 30 to 45 days. Getting started early can ensure that you have all the necessary communication with the ASC billing team. You're setting up your workflows, setting up your processes, and ultimately having all the systems you might be leveraging with that partnership set up and ready to go from day one.
RR: I think it's important to set very clear expectations of what's expected of both parties, especially when you're new in the relationship. You can't complete some duties without collaboration, so reconciling those expectations, being always on the same page, and working through any issues that come up until the whole process smooths out for everybody is important.
Then I think it should come to a point where the partnership works on a trust basis. I always tell people that outsourced ASC billing is a managed service, whether you do it in-house or whether it's outsourced. You still have to lead the process because the accountability falls back on the administrator or business office manager — whoever is leading the revenue cycle. You need to be involved and not completely leave it outsourced and not pay attention to the metrics. There's a great deal that needs to happen, but this work can be made much easier with a planned and staged approach. By doing so, I think that partnership should work out really well.
Access the recording of "Exploring the Drivers & Benefits of Outsourced Billing for ASCs: A Panel Discussion."